Oct 25, 2012
At 6.30 pm, I saw the Schnauzer licking vigorously the operation area till serum oozed out. I changed to a bigger e-collar.
Oct 30, 2012
In hindsight, the dog could have felt itchy in her op area as she was walked for more than 5 minutes every morning at around 9 am by my assistant Min. Movement affected healing and stretched the long skin incision. As at Oct 30, 2012, the dog was at home for the past 3 days and no problem is encountered. The vomiting had disappeared. Owner must follow up on urine analysis for the next 3 months, but most owners are time-pressed and fail to do so.
Wednesday, October 31, 2012
Tuesday, October 30, 2012
1164. Sudden onset uncontrollable panting in a young Tibetan Spaniel
Tuesday, October 30, 2012
1164. Sudden onset uncontrollable panting in a young Tibetan Spaniel
REVIEW OF AN UNUSUAL CASE
"I paid over $700 and the vet does not know what's wrong with my dog!" the owner had to paid for the emergency treatment for continuous panting which started on Friday at around 6 pm. She brought him to the emergency practice at 10.15 pm and the next morning, the dog was still furiously panting.
"It is not easy to diagnose what's wrong in some cases of uncontrollable continuous panting," I told the owner. I auscultated the lungs and heart on this fine sunny Saturday morning of Oct 26, 2012 at 10 am. The lung sounds were harsh and loud - the rhonchi and the rales of bovine pneumonia as that was what was taught in my Glasgow vet school in my final year in 1974.
Basically these were descriptions of the crackling noises in the lungs obscuring the heart sounds. Dr Jason Teo closed the muzzle while I placed the stethoscope inch by inch on the cardiac area of the left chest. I heard a "machinery murmur" in the midst of rapidly beating heart. It was just impossible to hear anything.
The dog had been panting non-controllably since 12 hours ago.
HISTORY
Thursday, Oct 25, 2012 - Nothing wrong. As usual playing on his own. Excellent appetite as usual.
Friday, Oct 26, 2012 - Did not poop since Oct 24. Brought him downstairs to walk and poop in the morning at 10am. Walked for only 10 minutes in the car park, not hot. Dog wanted to go home. Ate t home.
Then at 6 pm, dog started to pant heavily and continuously and at 10.15 pm, owner brought him to the emergency centre.
EMERGENCY CENTRE BLOOD TEST ON OCT 26, 2012 AROUND 10 PM
Tibetan Spaniel, MN, 28.4 lbs, 3 years, 39.8C
RBC low 1.95 (5.5 - 8.5)
HCT low 13.2% (37-55)
Hb is normal
WBC high 20 (5.5-17)
N 50%, L 37%, M 10%, E 3.4%, B 0.5% all normal
But L is high 7.15 (0.5-4.9), Platelet is low 62 (175-500)
High values for glucose 154 (74 - 143), TP 8.5 (5.2 - 8.2), GLOB 5 (2.5-4.5), TBIL 2.8 (0-0.9)
CHOL 159 (110-320) is normal
TOA PAYOH BLOOD TEST ON OCT 27, 2012 AROUND 11 AM on admission to Toa Payoh Vets. The dog had been treated by Vet 1 on Friday evening and overnight and had done a great job. But the owner was not impressed as the dog was still panting continuously.
13 kg 39.3 C. The significant findings are shown below:
TOA PAYOH BLOOD TEST ON OCT 27, 2012 AROUND 11 AM
Tibetan Spaniel, MN, 13kg, 3 years, 39.3C
Lipid profile
High total cholesterol 6.27, HDL chol 4.26, LDL < cannot be estimated due to interference from elevated triglyceride level, triglyceride 8.68
Liver profile
ALT 236 (<59 3151="3151" ast="ast">
Total WCC 26 (6-17)
N 95%, L 4.7%, M 0.3%, E 0%, B 0%. PCV and platelets normal. The neutrophil count at 95% is very high, indicating that the body produced lots of neutrophils to fight the bacteria in the blood and body.
The relevant finding for Vet 1 and me is that the total white cell is very high. This indicated a bacterial infection of the blood. This bacteria was of the type that the antibiotics took more than one day to control it.
My hypothesis: The heart, lungs and liver were infected and the dog was in great pain and therefore panted continuously as part of the whole process of infection.
The problem for me on this Saturday morning and afternoon was that the dog kept panting after the sedation of dom + ket given at 50% IV wore off. Continuous panting started after 2 hours. Gave IV diazepam, lasix and usual IV drips. At times, the tongue turned cyanotic. The panting was still continuous throughout the night but at 50% lesser pace. Nothing seemed to control it.
SUNDAY
Panting still persisted esp. after the owner visited with her 85-year-old mum who was most worried. The dog tried to stand up despite sedation. The owner changed the water bowl and wiped the dog. I told her not to stay more than one minute as the dog got excited and panted again. But she would not listen. The dog had "recovered" but that was due to medication. Soon the dog started to pant continuously again. "The dog is very sick and should not be visited," I said to her. One of my other clients said to me: "You are harsh to her." I told him that I had spent my Saturday afternoon ensuring that this dog's health was deteriorating and it should not be excited by getting up to greet the owner. I understand that the owner was anxious and worried to see her dog but visits ought to be very short in the interest of the canine patient.
"Do you visit a person in intensive care and change the bandages?" I asked her. "Let the dog rest and recover. If you insist on visiting the sick dog, please consider another clinic." It was a busy Saturday afternoon for me, trying to stabilise this dog as his panting would return once the sedation wore off. This was an unusual case but not uncommon.
If this dog kept panting for many hours and days, his heart would fail and he would die. The owner must understand the situation and not insist on patting the sick dog for the first day at least.
MONDAY
Got owner's permission to do X-rays of chest and abdomen again, ultrasound of abdomen (no gall bladder obstruction or pancreatitis, liver enlarged, urinary stones x2) and ultrasound of the heart (one coronary artery blocked 30%, dilated cardiac myopathy right heart). Panted again when brought to X-ray but much less.
TUESDAY
On heart medication. Dog no longer panted and the owner came to bring him home. Panted when brought out of the cage.
ADVICES
Some bacterial attack in the blood causing such sudden onset continuous panting. This would be my tentative diagnosis. Ultrasound did show 30% blockage in one coronary artery and Vet 3 diagnosed dilated cardiac myopathy of the right heart. Acute bacterial pericarditis?
The dog is obese and so high cholesterol and triglycerides were found. The dog should stay at home. Not going out for one month. No greeting neighbour's dog. Heart medication and H/D diet. This is an unusual case as continuous panting had persisted for over 48 hours despite medication. I agreed with a poor prognosis from Vet 1 but veterinary medicine is full of surprises. The dog survives after intensive treatment.
My associate vet said to me: "Better not to handle this case." I understood his concern he did not want any litigation and complaints if the critically ill dog with no hope should die at Toa Payoh Vets. Dogs do die and many owners don't forgive the vet. So I understand his advice. Yet, for this owner, it is hard for her if she had to go to the 3rd vet as time was of the essence in treating a continuous panting dog.
Day 1 of panting Day 3 of panting Day 3 of panting
Dog was not furiously panting on Day 3, so the X-rays are clearer. Ultrasound of the heart & abdomen were done
Bacteraemia was present on Day 1 & 2. The dog was stabilised on heart medication on Day 4 and is OK so far
Wednesday, October 31, 2012
1166. Follow up on heart attack obese Tibetan Spaniel
Wed Oct 31, 2012 at 7 pm, I phoned the owner as to the status of the panting of her 3-year-old Tibetan Spaniel weighing 13 kg and on heart medication.
She said: "He pants a little. But yesterday night, he slept well. Today he does not want to eat much. Usually he is very greedy. I tried feeding him the H/D diet but he would have none of it."
"It is expected as the H/D diet cannot be appetitising to him, " I said. "Just give 5% and mix with his usual chicken meat less fat."
"I gave him the dog treats which I had bought a lot," the owner did not heed my advice not to feed the red and green coloured rectangular pieces of dog treats as they might be the cause of bacterial infection in her dog. The total white cell count during the emergency and my treatment were very high, indicating a bacterial infection. A serious type of bacterial infection that cause continuous panting and heart attack on Friday evening and only on Tuesday morning was the dog back to normal breathing. But it is hard for the owner as the dog did not eat at all.
If the dog does not eat much, the owner is worried. The dog is recovering from a major infection and so may not have appetite. But it is best not to feed the processed dog treats as the quality is unknown. Many dog owners are not that well educated on this aspect.
In conclusion, the dog had short episodes of panting during walks and had recovered but this time, he just had uncontrolled continuous panting. A bacterial infection of the blood was present. As to the source of the bacteria, it could be from the dog treats or the soil during exercise.
Update at:
http://www.sinpets.com/dogs/20121101Tibetan_Spaniel_continuous_panting_toapayohvets.htm
1164. Sudden onset uncontrollable panting in a young Tibetan Spaniel
REVIEW OF AN UNUSUAL CASE
"I paid over $700 and the vet does not know what's wrong with my dog!" the owner had to paid for the emergency treatment for continuous panting which started on Friday at around 6 pm. She brought him to the emergency practice at 10.15 pm and the next morning, the dog was still furiously panting.
"It is not easy to diagnose what's wrong in some cases of uncontrollable continuous panting," I told the owner. I auscultated the lungs and heart on this fine sunny Saturday morning of Oct 26, 2012 at 10 am. The lung sounds were harsh and loud - the rhonchi and the rales of bovine pneumonia as that was what was taught in my Glasgow vet school in my final year in 1974.
Basically these were descriptions of the crackling noises in the lungs obscuring the heart sounds. Dr Jason Teo closed the muzzle while I placed the stethoscope inch by inch on the cardiac area of the left chest. I heard a "machinery murmur" in the midst of rapidly beating heart. It was just impossible to hear anything.
The dog had been panting non-controllably since 12 hours ago.
HISTORY
Thursday, Oct 25, 2012 - Nothing wrong. As usual playing on his own. Excellent appetite as usual.
Friday, Oct 26, 2012 - Did not poop since Oct 24. Brought him downstairs to walk and poop in the morning at 10am. Walked for only 10 minutes in the car park, not hot. Dog wanted to go home. Ate t home.
Then at 6 pm, dog started to pant heavily and continuously and at 10.15 pm, owner brought him to the emergency centre.
EMERGENCY CENTRE BLOOD TEST ON OCT 26, 2012 AROUND 10 PM
Tibetan Spaniel, MN, 28.4 lbs, 3 years, 39.8C
RBC low 1.95 (5.5 - 8.5)
HCT low 13.2% (37-55)
Hb is normal
WBC high 20 (5.5-17)
N 50%, L 37%, M 10%, E 3.4%, B 0.5% all normal
But L is high 7.15 (0.5-4.9), Platelet is low 62 (175-500)
High values for glucose 154 (74 - 143), TP 8.5 (5.2 - 8.2), GLOB 5 (2.5-4.5), TBIL 2.8 (0-0.9)
CHOL 159 (110-320) is normal
TOA PAYOH BLOOD TEST ON OCT 27, 2012 AROUND 11 AM on admission to Toa Payoh Vets. The dog had been treated by Vet 1 on Friday evening and overnight and had done a great job. But the owner was not impressed as the dog was still panting continuously.
13 kg 39.3 C. The significant findings are shown below:
TOA PAYOH BLOOD TEST ON OCT 27, 2012 AROUND 11 AM
Tibetan Spaniel, MN, 13kg, 3 years, 39.3C
Lipid profile
High total cholesterol 6.27, HDL chol 4.26, LDL < cannot be estimated due to interference from elevated triglyceride level, triglyceride 8.68
Liver profile
Total WCC 26 (6-17)
N 95%, L 4.7%, M 0.3%, E 0%, B 0%. PCV and platelets normal. The neutrophil count at 95% is very high, indicating that the body produced lots of neutrophils to fight the bacteria in the blood and body.
The relevant finding for Vet 1 and me is that the total white cell is very high. This indicated a bacterial infection of the blood. This bacteria was of the type that the antibiotics took more than one day to control it.
My hypothesis: The heart, lungs and liver were infected and the dog was in great pain and therefore panted continuously as part of the whole process of infection.
The problem for me on this Saturday morning and afternoon was that the dog kept panting after the sedation of dom + ket given at 50% IV wore off. Continuous panting started after 2 hours. Gave IV diazepam, lasix and usual IV drips. At times, the tongue turned cyanotic. The panting was still continuous throughout the night but at 50% lesser pace. Nothing seemed to control it.
SUNDAY
Panting still persisted esp. after the owner visited with her 85-year-old mum who was most worried. The dog tried to stand up despite sedation. The owner changed the water bowl and wiped the dog. I told her not to stay more than one minute as the dog got excited and panted again. But she would not listen. The dog had "recovered" but that was due to medication. Soon the dog started to pant continuously again. "The dog is very sick and should not be visited," I said to her. One of my other clients said to me: "You are harsh to her." I told him that I had spent my Saturday afternoon ensuring that this dog's health was deteriorating and it should not be excited by getting up to greet the owner. I understand that the owner was anxious and worried to see her dog but visits ought to be very short in the interest of the canine patient.
"Do you visit a person in intensive care and change the bandages?" I asked her. "Let the dog rest and recover. If you insist on visiting the sick dog, please consider another clinic." It was a busy Saturday afternoon for me, trying to stabilise this dog as his panting would return once the sedation wore off. This was an unusual case but not uncommon.
If this dog kept panting for many hours and days, his heart would fail and he would die. The owner must understand the situation and not insist on patting the sick dog for the first day at least.
MONDAY
Got owner's permission to do X-rays of chest and abdomen again, ultrasound of abdomen (no gall bladder obstruction or pancreatitis, liver enlarged, urinary stones x2) and ultrasound of the heart (one coronary artery blocked 30%, dilated cardiac myopathy right heart). Panted again when brought to X-ray but much less.
TUESDAY
On heart medication. Dog no longer panted and the owner came to bring him home. Panted when brought out of the cage.
ADVICES
Some bacterial attack in the blood causing such sudden onset continuous panting. This would be my tentative diagnosis. Ultrasound did show 30% blockage in one coronary artery and Vet 3 diagnosed dilated cardiac myopathy of the right heart. Acute bacterial pericarditis?
The dog is obese and so high cholesterol and triglycerides were found. The dog should stay at home. Not going out for one month. No greeting neighbour's dog. Heart medication and H/D diet. This is an unusual case as continuous panting had persisted for over 48 hours despite medication. I agreed with a poor prognosis from Vet 1 but veterinary medicine is full of surprises. The dog survives after intensive treatment.
My associate vet said to me: "Better not to handle this case." I understood his concern he did not want any litigation and complaints if the critically ill dog with no hope should die at Toa Payoh Vets. Dogs do die and many owners don't forgive the vet. So I understand his advice. Yet, for this owner, it is hard for her if she had to go to the 3rd vet as time was of the essence in treating a continuous panting dog.
Day 1 of panting Day 3 of panting Day 3 of panting
Dog was not furiously panting on Day 3, so the X-rays are clearer. Ultrasound of the heart & abdomen were done
Bacteraemia was present on Day 1 & 2. The dog was stabilised on heart medication on Day 4 and is OK so far
Wednesday, October 31, 2012
1166. Follow up on heart attack obese Tibetan Spaniel
Wed Oct 31, 2012 at 7 pm, I phoned the owner as to the status of the panting of her 3-year-old Tibetan Spaniel weighing 13 kg and on heart medication.
She said: "He pants a little. But yesterday night, he slept well. Today he does not want to eat much. Usually he is very greedy. I tried feeding him the H/D diet but he would have none of it."
"It is expected as the H/D diet cannot be appetitising to him, " I said. "Just give 5% and mix with his usual chicken meat less fat."
"I gave him the dog treats which I had bought a lot," the owner did not heed my advice not to feed the red and green coloured rectangular pieces of dog treats as they might be the cause of bacterial infection in her dog. The total white cell count during the emergency and my treatment were very high, indicating a bacterial infection. A serious type of bacterial infection that cause continuous panting and heart attack on Friday evening and only on Tuesday morning was the dog back to normal breathing. But it is hard for the owner as the dog did not eat at all.
If the dog does not eat much, the owner is worried. The dog is recovering from a major infection and so may not have appetite. But it is best not to feed the processed dog treats as the quality is unknown. Many dog owners are not that well educated on this aspect.
In conclusion, the dog had short episodes of panting during walks and had recovered but this time, he just had uncontrolled continuous panting. A bacterial infection of the blood was present. As to the source of the bacteria, it could be from the dog treats or the soil during exercise.
Update at:
http://www.sinpets.com/dogs/20121101Tibetan_Spaniel_continuous_panting_toapayohvets.htm
Friday, October 26, 2012
1162. A 15-year-old Persian cat
"I went to Vet 1 twice and blood tests were done twice," the man in his late 60s said. "Nothing wrong. I was asked to give A/D by mouth daily and I have been doing it for 2 weeks. My cat is losing weight and not eating. She used to eat well till two weeks ago."
I did an abdominal palpation. The thin kidney meowed when I palpated the left kidney. I advised a blood test. The clues from the owner are important. He said: "My cat would look forward to the dry cat food but after one bite, would not eat."
"Is there mouth ulcers?" I asked. The cat clawed me and objected strenuously to her mouth being opened. I could see one left upper canine tooth gum was much bigger at around 5X the other. Was there a gum tumour causing pain? Was this swelling present at young?
What is the solution? I advised another blood test. But what is the diagnosis and the solution?
This is a difficult case. Dr Daniel said there was a big firm lump in mid-abdomen. Yes, there was one but it could be the kidney or bladder. He was sure they could be intestinal or abdominal tumours. "An X-ray may show," I said.
I gave the cat an IV drip and medication. Will need to wait and see after the blood test results come in.
I did an abdominal palpation. The thin kidney meowed when I palpated the left kidney. I advised a blood test. The clues from the owner are important. He said: "My cat would look forward to the dry cat food but after one bite, would not eat."
"Is there mouth ulcers?" I asked. The cat clawed me and objected strenuously to her mouth being opened. I could see one left upper canine tooth gum was much bigger at around 5X the other. Was there a gum tumour causing pain? Was this swelling present at young?
What is the solution? I advised another blood test. But what is the diagnosis and the solution?
This is a difficult case. Dr Daniel said there was a big firm lump in mid-abdomen. Yes, there was one but it could be the kidney or bladder. He was sure they could be intestinal or abdominal tumours. "An X-ray may show," I said.
I gave the cat an IV drip and medication. Will need to wait and see after the blood test results come in.
1161. A happy father
Hari Raya Puasa story
It is very rare to see a father sending the adult daughter and her dog to Toa Payoh Vets but this father did it. The daughter had bought a very small and thin Shetland collie from the pet shop without the father's knowledge.
"Children do that," I said to him. "They just buy the puppy and bring her home in case you object if she ask you for permission."
"I keep dogs," he said. "I don't object. But she has bought a stunted weak and thin Sheltie."
"Some mothers do object," I said. "Could it be your wife?"
"Yes," he said. "In the end, the parents have to look after the dog. Why did she buy such a poor specimen?" He could easily have paid for a good quality puppy. In any case, this Sheltie was 9 months old and was at the kennel for some months, without a hope of a sale.
"Women are kinder to the disadvantaged and sick animals than men," I said. "What would happen to all the weaker dogs if every woman buys just the pick of the litter or nothing? I will examine her heart and lungs and do the blood test to check whether the kidney and liver are ok."
The Sheltie objected strongly to me examining her mouth. She even bit my assistant. "There's gingivitis. See the red line at the gum-tooth level. It is painful. There is tartar and the 4 puppy canine teeth which had not dropped off. Take antibiotics for 7 days and come for dental work."
So, today Hari Raya Puasa was the appointment date. I was taking pictures of the hamster patients (one with skin behind the head and above the neck very itchy and the other one with pus in the swollen right eye). The father and daughter came with the Sheltie.
"The dog is more active and eating after the antibiotics," the daughter told me. "The gums are less inflamed and the red line between the teeth and the gum had vanished by 90%". Under general anaesthesia, the 4 puppy canine teeth were extracted by Dr Daniel.
"Are you a happy father now?" I asked the gentleman who is probably the same age as me. "The blood test confirmed no liver or kidney or blood system problems. This Sheltie is just born small sized."
Yes," he nodded. I was most happy for the dog too. She had lived inside the pet shop for at least 9 months and had difficulty eating due to the obstruction and pain from the retained teeth.
It is very rare to see a father sending the adult daughter and her dog to Toa Payoh Vets but this father did it. The daughter had bought a very small and thin Shetland collie from the pet shop without the father's knowledge.
"Children do that," I said to him. "They just buy the puppy and bring her home in case you object if she ask you for permission."
"I keep dogs," he said. "I don't object. But she has bought a stunted weak and thin Sheltie."
"Some mothers do object," I said. "Could it be your wife?"
"Yes," he said. "In the end, the parents have to look after the dog. Why did she buy such a poor specimen?" He could easily have paid for a good quality puppy. In any case, this Sheltie was 9 months old and was at the kennel for some months, without a hope of a sale.
"Women are kinder to the disadvantaged and sick animals than men," I said. "What would happen to all the weaker dogs if every woman buys just the pick of the litter or nothing? I will examine her heart and lungs and do the blood test to check whether the kidney and liver are ok."
The Sheltie objected strongly to me examining her mouth. She even bit my assistant. "There's gingivitis. See the red line at the gum-tooth level. It is painful. There is tartar and the 4 puppy canine teeth which had not dropped off. Take antibiotics for 7 days and come for dental work."
So, today Hari Raya Puasa was the appointment date. I was taking pictures of the hamster patients (one with skin behind the head and above the neck very itchy and the other one with pus in the swollen right eye). The father and daughter came with the Sheltie.
"The dog is more active and eating after the antibiotics," the daughter told me. "The gums are less inflamed and the red line between the teeth and the gum had vanished by 90%". Under general anaesthesia, the 4 puppy canine teeth were extracted by Dr Daniel.
"Are you a happy father now?" I asked the gentleman who is probably the same age as me. "The blood test confirmed no liver or kidney or blood system problems. This Sheltie is just born small sized."
Yes," he nodded. I was most happy for the dog too. She had lived inside the pet shop for at least 9 months and had difficulty eating due to the obstruction and pain from the retained teeth.
1160. Follow up: A happy Hari Raya Puasa. The constipated Hougang cat
Today, Freiday Oct 26, 2012 is Hari Raya Puasa, breaking the fast for the Malays. I was at the office at 8.45 am.
It was too early to phone but I would not have time later. I dialed the handphone of the well-groomed and well-dressed Malay lady with the 2-year-old Hougang cat that came yesterday evening. Her cat was spayed by Dr Daniel 5 days ago. But Nike was meowing and panting yesterday afternoon at around 4 pm. I could hear the sounds of the cat over her phone call. "She has not pooped since the spay," the lady said. "What shall I do? I am worried about this non-stop panting and panting."
"I advise coming to me for examination and to give an enema," I said. "If you wait and see, and if the cat's panting and meowing worsen after midnight, you will have to pay a lot of money for emergency treatment!"
At 7 pm, the cat came. She was normal and her panting had stopped. One cool cat not bothered with the dogs barking in the waiting room. "My husband is in the car outside," the lady said. "I am not afraid of dogs. Shall I go home since the cat is now normal?"
This was a tough question. If I said yes and the cat's symptoms returned past midnight, the lady would have to pay 3-4X normal vet fees. She would be more stressed as she loves this cat very much. Non-stop meowing is as stressful as non-stop panting for a cat owner. The neighbours may be disturbed too.
"It is better than I sedate the cat and put in an enema tube in her anus," I said. "If the cat is not fierce, I would not need to sedate. However, this cat scratches and if I give the enema without sedation, there will be no second chance."
So, the lady with her reddish brown silky Malay headwear and clothing held the cat, placed on my operating table, tightly on the chest area. My assistant Min held the right hind leg while I squeezed into the narrow corner looking for the back muscle of the left hind leg and not intruding into the personal space of the lady. I injected. The cat jumped a bit but her owner held tight. "Put her back into the carrier," I said. In the owner's presence, the domestic cat seldom becomes frightened and attack the vet. I asked the lady to wait in the waiting area.
In 10 minutes, the cat was sedated. My assistant Min pressed the rectal area. A 1-cm brown piece of stool came out. There was no more. "Hold the cat's backside upright," I said to Min. "Pump in the enema fluid." I put the cat back into the carrier.
"All the stools have come out?" the lady asked while her husband patiently waited outside in his parked car.
"No," I said. "All systems including the intestines shut down during sedation. The stools will come out when the cat is awake."
"When?" she asked.
"Most likely next day." Sedation: Xylazine 0.15 Ket 0.6 ml IM, 2 year old
FRIDAY OCT 26, 2012 I phoned the owner. Hari Raya Puasa. Her husband asked her to answer my phone call.
"How's Nike?", I asked. "What time did she wake up from sedation?"
"He woke up at 2 am. She vomited 5X. Food and water."
"What time did she wake up in the morning?"
"I woke up at 6am and I saw her walking around the apartment," the lady thought I was asking about her waking up. "I gave her food and you know what?"
"What happened?" I asked.
"She pooped a lot!"|
"What do you mean a lot?" I asked.
"A very long piece. From the end of my middle finger to my wrist! Jhard and solid. And two small pieces of the size of my thumb!"
"Was there any hair inside the long stool?" I asked.
"I did not check," she said. "But there was a big hairball when she vomited at 2 am."
"Does your cat groom a lot?' I asked.
"What do you mean?"
"I mean every few seconds, she would clean her fur."
"No, but she would groom for a long period of time when she is not playing with me."
This was a most happy cat owner on Hari Raya Puasa. She had agonised for 2 years as to whether to spay her cat or not and when she decided, the cat would not take the medication. She had asked her husband to collect some antibiotics and pain-killers as the cat threw out 50% of the medication. So the husband came on the 3rd day after spay. And on the 4th day, this cat meowed and panted in the afternoon, further worrying her.
It was a happy ending. If I had asked her to "wait and see", the constipation would be harder to treat as the stools would be very hard. The cat would feel the pain of passing motion and that could be why she panted. I had asked her to feel the hard long stools of the colon when the cat was sedated yesterday. She could feel it, but nothing as impressive as the passage of the hard stools this morning!
As for the spay wound, it was very clean as the lady showed to me. Not a bit of inflammation as she had taken great care to give her cat medication and pain-killers as instructed. Most owners would just give up.
It was too early to phone but I would not have time later. I dialed the handphone of the well-groomed and well-dressed Malay lady with the 2-year-old Hougang cat that came yesterday evening. Her cat was spayed by Dr Daniel 5 days ago. But Nike was meowing and panting yesterday afternoon at around 4 pm. I could hear the sounds of the cat over her phone call. "She has not pooped since the spay," the lady said. "What shall I do? I am worried about this non-stop panting and panting."
"I advise coming to me for examination and to give an enema," I said. "If you wait and see, and if the cat's panting and meowing worsen after midnight, you will have to pay a lot of money for emergency treatment!"
At 7 pm, the cat came. She was normal and her panting had stopped. One cool cat not bothered with the dogs barking in the waiting room. "My husband is in the car outside," the lady said. "I am not afraid of dogs. Shall I go home since the cat is now normal?"
This was a tough question. If I said yes and the cat's symptoms returned past midnight, the lady would have to pay 3-4X normal vet fees. She would be more stressed as she loves this cat very much. Non-stop meowing is as stressful as non-stop panting for a cat owner. The neighbours may be disturbed too.
"It is better than I sedate the cat and put in an enema tube in her anus," I said. "If the cat is not fierce, I would not need to sedate. However, this cat scratches and if I give the enema without sedation, there will be no second chance."
So, the lady with her reddish brown silky Malay headwear and clothing held the cat, placed on my operating table, tightly on the chest area. My assistant Min held the right hind leg while I squeezed into the narrow corner looking for the back muscle of the left hind leg and not intruding into the personal space of the lady. I injected. The cat jumped a bit but her owner held tight. "Put her back into the carrier," I said. In the owner's presence, the domestic cat seldom becomes frightened and attack the vet. I asked the lady to wait in the waiting area.
In 10 minutes, the cat was sedated. My assistant Min pressed the rectal area. A 1-cm brown piece of stool came out. There was no more. "Hold the cat's backside upright," I said to Min. "Pump in the enema fluid." I put the cat back into the carrier.
"All the stools have come out?" the lady asked while her husband patiently waited outside in his parked car.
"No," I said. "All systems including the intestines shut down during sedation. The stools will come out when the cat is awake."
"When?" she asked.
"Most likely next day." Sedation: Xylazine 0.15 Ket 0.6 ml IM, 2 year old
FRIDAY OCT 26, 2012 I phoned the owner. Hari Raya Puasa. Her husband asked her to answer my phone call.
"How's Nike?", I asked. "What time did she wake up from sedation?"
"He woke up at 2 am. She vomited 5X. Food and water."
"What time did she wake up in the morning?"
"I woke up at 6am and I saw her walking around the apartment," the lady thought I was asking about her waking up. "I gave her food and you know what?"
"What happened?" I asked.
"She pooped a lot!"|
"What do you mean a lot?" I asked.
"A very long piece. From the end of my middle finger to my wrist! Jhard and solid. And two small pieces of the size of my thumb!"
"Was there any hair inside the long stool?" I asked.
"I did not check," she said. "But there was a big hairball when she vomited at 2 am."
"Does your cat groom a lot?' I asked.
"What do you mean?"
"I mean every few seconds, she would clean her fur."
"No, but she would groom for a long period of time when she is not playing with me."
This was a most happy cat owner on Hari Raya Puasa. She had agonised for 2 years as to whether to spay her cat or not and when she decided, the cat would not take the medication. She had asked her husband to collect some antibiotics and pain-killers as the cat threw out 50% of the medication. So the husband came on the 3rd day after spay. And on the 4th day, this cat meowed and panted in the afternoon, further worrying her.
It was a happy ending. If I had asked her to "wait and see", the constipation would be harder to treat as the stools would be very hard. The cat would feel the pain of passing motion and that could be why she panted. I had asked her to feel the hard long stools of the colon when the cat was sedated yesterday. She could feel it, but nothing as impressive as the passage of the hard stools this morning!
As for the spay wound, it was very clean as the lady showed to me. Not a bit of inflammation as she had taken great care to give her cat medication and pain-killers as instructed. Most owners would just give up.
The Brazilian girl's hamster has a swollen eye
Dwarf hamsters are quite popular in Singapore in 2012 as Toa Payoh Vets see more hamster cases nowadays. Yesterday I asked a Japanese mother on how she selected Toa Payoh Vets.
"I google hamster vets," she said that not all vets treat hamsters. "I saw your webpage."
What she said is true in my backyard. One of my associate vets prefers not to perform hamster surgery at any time as they are such fragile anaesthetic risks.
"No, you did not," the pretty and fair 8-year-old Brazilian daughter said. "You google Singapore vet."
"I did not," the Japanese mother replied. "You saw Singapore vet. I type hamster vet in Singapore."
"Children nowadays are very observant and watch what mothers do," I was much impressed with this little girl's close bonding with the mum. "How old is your hamster?"
"We bought her in January 2010," she said.
"That would make her 2 years and 9 months old," I noted that this hamster with the left swollen eyelids was not so active.
"Dr Vanessa will examine the hamster with me," I said. "Does she bite people?"
"Sometimes."
Dr Vanessa wore her glove in her right hand to weigh and examine the hamster's swollen eye. She pressed down the lower eyelid. Pus oozed out.
"We have to hospitalise the hamster for one day, anaesthesized her to remove the pus from inside the eyelids," I said. "Anaesthesia will permit us to do a proper job of lancing the abscess."
Some vets will prescribe eye drops but it will not work in this case as the eyelid abscesses are large.
It is best to equip yourself with the appropriate surgical tools for hamster surgeries as the ones for the dog and cat are too big. See pictures below.
"I google hamster vets," she said that not all vets treat hamsters. "I saw your webpage."
What she said is true in my backyard. One of my associate vets prefers not to perform hamster surgery at any time as they are such fragile anaesthetic risks.
"No, you did not," the pretty and fair 8-year-old Brazilian daughter said. "You google Singapore vet."
"I did not," the Japanese mother replied. "You saw Singapore vet. I type hamster vet in Singapore."
"Children nowadays are very observant and watch what mothers do," I was much impressed with this little girl's close bonding with the mum. "How old is your hamster?"
"We bought her in January 2010," she said.
"That would make her 2 years and 9 months old," I noted that this hamster with the left swollen eyelids was not so active.
"Dr Vanessa will examine the hamster with me," I said. "Does she bite people?"
"Sometimes."
Dr Vanessa wore her glove in her right hand to weigh and examine the hamster's swollen eye. She pressed down the lower eyelid. Pus oozed out.
"We have to hospitalise the hamster for one day, anaesthesized her to remove the pus from inside the eyelids," I said. "Anaesthesia will permit us to do a proper job of lancing the abscess."
Some vets will prescribe eye drops but it will not work in this case as the eyelid abscesses are large.
It is best to equip yourself with the appropriate surgical tools for hamster surgeries as the ones for the dog and cat are too big. See pictures below.
Thursday, October 25, 2012
1157. KPI - Uroliths surgery. Audit of one calcium oxalate case
Date of Audit: Oct 25, 2012
Urolithiasis - bladder stones calcium oxalate removed by an associate vet, Dr Vanessa
Owner has financial constraints
Oct 2.2012
Maltese, Male, 9 years, 3.1 kg, 38.5C
Straining to urinate. Blood in the urine
Anaesthesia & Surgery Record No. 207
Declined urine analysis
X-rays done
Cystotomy - several uroliths
Stone analysis - Calcium oxalate
Sutures - monosyn 3/0 x 2 packets
C-B: Isoflurane + O2 on to switched off - 46 minutes
E-D: Skin stitched up from lst skin incision - 43 minutes
E-A: Sedation injected to skin stitched - 66 minutes
COMPARISON TO ONE CASE OF EXPLORATORY LAPAROTOMY & CYSTOSTOMY DONE ON A MINIATURE SCHNAUZER BY ME (DR SING KONG YUEN) IN OCT 2012
ANAESTHESIA
A: Inject sedation drug 10.20am
B: Isofl first given 10.27 am. Mask, then intubate. Dog vomited again.
C: Isofl stopped 11.37 am
D: First skin incision 10.39 am
E: Completion of skin stitching 11.37 am
E-A = 57 min
E-D = 58 min (time taken to check out stomach, kidneys visually and remove >10 bladder stones)
C-B = 64 min
No post-op complaints as at Oct 25, 2012. Phoned owner at 11.30 am today. No response from phone. Phoned home number. Spoke to a lady. Dog is OK. No urination problems. Had stitched removed. This urination problem existed for some months. Advised to see associate vet who operated on this dog, regarding the feeding of U/D diet and stop feeding dry food presently given.
Urolithiasis - bladder stones calcium oxalate removed by an associate vet, Dr Vanessa
Owner has financial constraints
Oct 2.2012
Maltese, Male, 9 years, 3.1 kg, 38.5C
Straining to urinate. Blood in the urine
Anaesthesia & Surgery Record No. 207
Declined urine analysis
X-rays done
Cystotomy - several uroliths
Stone analysis - Calcium oxalate
Sutures - monosyn 3/0 x 2 packets
C-B: Isoflurane + O2 on to switched off - 46 minutes
E-D: Skin stitched up from lst skin incision - 43 minutes
E-A: Sedation injected to skin stitched - 66 minutes
COMPARISON TO ONE CASE OF EXPLORATORY LAPAROTOMY & CYSTOSTOMY DONE ON A MINIATURE SCHNAUZER BY ME (DR SING KONG YUEN) IN OCT 2012
ANAESTHESIA
A: Inject sedation drug 10.20am
B: Isofl first given 10.27 am. Mask, then intubate. Dog vomited again.
C: Isofl stopped 11.37 am
D: First skin incision 10.39 am
E: Completion of skin stitching 11.37 am
E-A = 57 min
E-D = 58 min (time taken to check out stomach, kidneys visually and remove >10 bladder stones)
C-B = 64 min
No post-op complaints as at Oct 25, 2012. Phoned owner at 11.30 am today. No response from phone. Phoned home number. Spoke to a lady. Dog is OK. No urination problems. Had stitched removed. This urination problem existed for some months. Advised to see associate vet who operated on this dog, regarding the feeding of U/D diet and stop feeding dry food presently given.
Wednesday, October 24, 2012
Health check on a big-sized 13-year-old male Jack Russell
The lady owner was studying medicine in the US. When she came back for a holiday, her Jack Russell was scratching his eyes till the eyelids bled, his chest so that it was red and his penile skin till it was bald, the four paws with deep red blood in between the toes and on the toes. What was the cause? Yet the ears were spared but I saw crusty lumps on the edges of the left ear. Scabies? Allergy? Demodecosis? Skin scrapings were negative.
Blood test - monocytes higher than normal at 11.2%. Other values are normal.
Calcium and uric acid within normal range. Liver, kidney, joints normal.
Dental scaling done.
X-rays showed no radio-dense urinary stones but there is possibly one in the bladder area. It is hard to tell on the lateral view of the X-ray.
Urine showed calcium oxalate crystals
pH 6.5, SG 1.022, Protein 2+, Blood trace, Crystals calcium oxalate occasional, bacteria occasional.
The "occasional" presence of calcium oxalate does not mean there are no urinary stones. Absence of crystals does not mean there are no urinary stones. Much depends on the clinical signs of blood in the urine. The dog was furiouslylicking its penile length till the area was red and hairless. This was unusual. There could be difficulty in urination but nobody knows as the caregiver owner was studying in the US.
FEEDING OF U/D CANINE NON-STRUVITE URINARY TRACT HEALTH
Indications: Urolithiasis due to calcium oxalate, urate and cystine stones; end-stage kidney disease
Decreases purine intake and uric acid excrerion, which lowers the risk of forming urate crystals and uroliths
Monitoring Urine SG, urinarypH and BUN will let the vet know the food's effectiveness and owner compliance. Dogs fed on this diet commonly show unusual lab values like USG <1 .020=".020" bun="bun" dl="dl" mg="mg" p="p">
Long term use: Check for protein depletion as U/D is a low protein diet to decrease urea production, but the protein level is suitable for maintenance of the adult dog. Advise a fasting serum chemistry profile and ECG every 6 months.
Blood test - monocytes higher than normal at 11.2%. Other values are normal.
Calcium and uric acid within normal range. Liver, kidney, joints normal.
Dental scaling done.
Urine showed calcium oxalate crystals
pH 6.5, SG 1.022, Protein 2+, Blood trace, Crystals calcium oxalate occasional, bacteria occasional.
The "occasional" presence of calcium oxalate does not mean there are no urinary stones. Absence of crystals does not mean there are no urinary stones. Much depends on the clinical signs of blood in the urine. The dog was furiouslylicking its penile length till the area was red and hairless. This was unusual. There could be difficulty in urination but nobody knows as the caregiver owner was studying in the US.
FEEDING OF U/D CANINE NON-STRUVITE URINARY TRACT HEALTH
Indications: Urolithiasis due to calcium oxalate, urate and cystine stones; end-stage kidney disease
Decreases purine intake and uric acid excrerion, which lowers the risk of forming urate crystals and uroliths
Monitoring Urine SG, urinarypH and BUN will let the vet know the food's effectiveness and owner compliance. Dogs fed on this diet commonly show unusual lab values like USG <1 .020=".020" bun="bun" dl="dl" mg="mg" p="p">
Long term use: Check for protein depletion as U/D is a low protein diet to decrease urea production, but the protein level is suitable for maintenance of the adult dog. Advise a fasting serum chemistry profile and ECG every 6 months.
Tuesday, October 23, 2012
1155. A hamster from Italy
On Sun, Oct 14, 2012 at 7:21 PM, Valentina C...@gmail.com> wrote:
Thank you for your email. It is hard to see from your 2 images what is the affected area you mentioned. It is best to consult your vet.
Dear Sir/Madam,
I am Valentina and I am writing from Italy. I have a one-year-old dwarf male hamster and he has got a problem; I only realized it yesterday. I follow from here all your surgery cases and your successes, the photos and the articles on the web site, so I thought it was better to write down a line to have an advice from you, because you are experts and I admire your job.
This is my first hamster and I do not what to do, really, I am desperate, because so far we had any kind of problems. The problem is related to its lower area of the body, and it's like an abscess or a tumor or something like that because it is a hard distended underskin lump near the penus.
Here in Italy the vets are closed on saturday and sunday so I medicated it as I could on my own, doing some chamomile hot packs.
EMAIL REPLY FROM DR SING DATED OCT 23, 2012Do you think he probably will go through a surgery? What am I supposed to do? Please help me, I'm sending you some photos. Talking about the hamster, he is acting as normal, it is not weak, he plays, eats, sleeps.... Thanks a lot, you really do not know how important is to me if you answer back. Sorry to bother you.Your sincerely,Valentina C.
Thank you for your email. It is hard to see from your 2 images what is the affected area you mentioned. It is best to consult your vet.
1154. The urinary stone Schnauzer barks and eats at 6.47 pm
Tuesday Oct 23, 2012 6.47 pm
I asked Dr Daniel to bring JJ out for a walk at 6 pm. Evening sunset, tranquility. This dog had not wanted to eat since my surgery on last Saturday and I am most worried. The owners visited her every afternoon.
Dr Daniel said: "The owners say that this dog does not eat after surgery and it is common."
JJ walked out with a spring in her step. She peed outside and the urine was yellow and has no signs of blood unlike this morning.
Suddenly she barked at a jogger. This was excellent news. A dog that barks suddenly at joggers is on the road to recovery. Dr Daniel took off her e-collar and gave her canned food. She ate and my worries of the post-op decline in health vanished. She walked up and down the back room looking for Dr Daniel. She sat on her back. "Put her back into the cage," I said.
I asked Dr Daniel to bring JJ out for a walk at 6 pm. Evening sunset, tranquility. This dog had not wanted to eat since my surgery on last Saturday and I am most worried. The owners visited her every afternoon.
Dr Daniel said: "The owners say that this dog does not eat after surgery and it is common."
JJ walked out with a spring in her step. She peed outside and the urine was yellow and has no signs of blood unlike this morning.
Suddenly she barked at a jogger. This was excellent news. A dog that barks suddenly at joggers is on the road to recovery. Dr Daniel took off her e-collar and gave her canned food. She ate and my worries of the post-op decline in health vanished. She walked up and down the back room looking for Dr Daniel. She sat on her back. "Put her back into the cage," I said.
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