1104. An 8-year-old Shih Tzu vomits after eating and drinking

TP 45665

"My dog did eat a squarish piece of bone," the lady owner told me it was around 2.5 cm x 2.5 cm. The dog had been vomiting after eating and drinking during the past 3 days.

There was sore throat but no abdominal pain. X-rays were taken. There could be a bone fragment but it was not obvious in the intestinal tract full of gas.

The owner did not want a blood test which would be very useful in finding a cause. She just wanted the dog treated. I put the dog on a IV drip with antibiotics and anti-spasomgesic for one day. The dog went back the next day with I/D canned food and medication.


BLOOD TEST RESULT ON NOV 14, 2014   

I did a blood test which showed a blood borne bacterial infection with total white cell count 26.9 (6-17), neutrophils 89% (60-70) and absolute neutrophil numbers 23.94 (3-11.5).

Liver enzymes were up. SGPT 109 (less than 59), SGOT 111 (less than 81).


FOLLOW UP
Phoned 15.11.14. No more vomiting. The owner was quite happy. 

Based on the blood evidence, the cause of vomiting could be due to hepatitis and gastritis due to swallowing of a piece of bone. After 2 days, the dog started vomiting again. The dog had diarrhoea. According to the owner, the dog did not eat the squarish bone but ate other small bone fragments.



It is best to diagnosed based on medical evidence of blood test but many Singapore owners do not want to pay for the test.

1103. BKTP Liver tumour image

Green colour does not look good in this image

1102. SCRIPT FOR INTERNS RGS. Ear tumours. Recurring ear canal tumour in an old Jack Russell

Nov 14, 2014

In old dogs, some tumours are malignant. However, many owners do not want to pay for histology to check whether the tumours are malignant. In this case, the tumour at the entrance of the vertical ear canal had been excised by another vet. The tumour came back and grew much bigger.

Vertical ear canal ablation, ie.. the removal of the vertical ear canal is the best option and was done by Dr Daniel.

Ear tumours at the entrance of the vertical canal can become infected or obstruct the ventilation of the ear canals. The  dog keeps scratching and the infections cause a bad smell.

Ear canal tumours are not common. This is the second case in 2014. In the first case, the old Husky had a smelly itchy ear. Vertical ear canal ablation by me resolved his problem. Video produced.

1101. Internship and experiential learning

Nov 14, 2014

Hi Dr Sing,

We have come to the end of another cycle of our Gap Semester and once again, I would like to thank Toa Payoh Vets for allowing our boys to be attached to you.

We asked the boys about the programme and they were very positive about their experience with you.  We hope they have not caused you and your colleagues too much trouble.

FEEDBACK FROM BOYS

I have attached some feedback from the boys.  Included are some words of appreciation which they had submitted on their own accord.

LOOKING TO 2015

We hope to continue this partnership with you next year. 

Possible dates:

Currently, the possible blocks of dates for next year are:

Block 1- 2 to 15 Aug (2 weeks)

Block 2 - 16 to 29 Aug (2 weeks)

Block 3 - 13 to 26 Sep (2 weeks)

Number of boys

This year, we had vacancies for 4 boys (2 in Block 1 and 2 in Block 2).

Can we continue with the same number/dates or will you like to offer more vacancies and choose a different block(s)?

Description

Based on this year, the description of the Work Attachment is as follows:

Career Field/Interest	·         Interest in Veterinary Medicine
Pre-requisites/ Expectations	·         Minimum GP of 4.0 for Biology ·         Must love/want to work with animals ·         Preferably able to do/learn simple video production using Windows Movie Maker ·         Willing to work in an environment which requires you to come in direct contact with animals and animal wastes.
Description	·         Students will be shadowing a Veterinary doctor ·         They will be observing and working in a real environment dealing with animal healthcare.  Hence, students must not have an aversion to the sight and smell of blood and must be comfortable in handling animals. ·         As part of the attachment, students will be tasked to do simple video recording and production for educational and research purposes.

Would we be able to proceed with this arrangement for next year?

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

Thank you for your interesting feedback. Most of the young interns want are to see all the cases and then go home happily. If there are two at one time, they prefer to chat and do their own things. As they do not work long hours or weekends, they have little time to create videos of their cases or do research. So they have to do time management and not see every case. Seeing is more fun. Writing is a chore for the young generation.  

Case recording and then video production of the case is an important part of experiential learning (if I have got the spelling correct). I improve my skills and expertise by doing this as I will do more research on the particular disease to create quality content in my case report on my blog or video.

Video creation takes too much time as there is a need for me to teach and revise many of the interns' drafts and edit their grammatical errors.   

Many interns e.g. Intern G was given the least video work compared to his counterpart when I assess they are not so capable of video creation. He still has not edited the video I had asked him through you as he had not contacted me. Once the interns leave with uncompleted work, they seldom bother to complete.  

I will be available in the mornings from 9.30 am to 11 am on weekdays. Pl tel me 9668 6468 one day in advance to meet.    

Bilateral carnaissal tooth abscesses in a Jack Russell

1099. SCRIPT FOR INTERNS RGS. How to take care of your sneezing dwarf rabbit

Nov 12, 2014
5 month old female rabbit
sneezing occasionally past 2 months and more sneezing recently

1. No pus. Just clear mucus from nose. Moderate amount. I used tissue to wipe the nose to check colour of nasal discharge.

2. Rapid breathing.
3. Lung sounds - harsh, generalised in both lungs.


DUST
1. Fine alfalfa hay with dust
2. Dry shampoo for bunnies - dust
3. Under the sofa - has dust
4. Pellets with seeds - dusty

HOUSING SPACE. Too cramped ---> breathes in dust
Crate too small now as she is 5 months old, weighing one kg. There is no space to turn. Length of body = half length of crate.
So owner took away the pee tray but the rabbit wanted the pee tray. Feed bowl.
Underside of back feet - decolourised with urine.  

1098. SCRIPT FOR INTERNS RGS. How to prevent swollen eyes in terrapins in a city

Early detection & veterinary treatment saves eyes

1. Hook  - Vet's dialogue with owner.
2. Be Kind to Pets - Theme
3. Introduction
    Singapore in 2014. Mostly apartment living. Few landed houses. Harried life. Video clips. 
                                   Terrapins hatchlings from wet market or pet shop. Video.
                                   Feeding. Most owners feed pellets. From Taiwan. Sample. Eat and poop in same water area.
                                   Housing. Aquarium tank. set up. Sample. Illustration.
                                                  Water level low. No daily change of water. No filter.
                                                  Basking. Dry. Rocks. Floaters, Ramp. No UV light.
                                                  No sunlight.
                                                  Flooring tiled for bigger one.

4. Middle
                 Case studies
                 Eye metaplasia
                 Eye + respiratory problems
                   Eye + shell rot.
                   Eye + chlorinated drops
                   Position of UVL light to dry the shell
                   Water filter not washed
                   Daily change of water, very smelly stools - see one case of 2 healthy terrapins kept by one owner. No eye problem. Video. 


5. Conclusion





                Hygiene of water in tanks. Nutrition (expired, quality of pellets), no seafood, fishes or shrimps when young.  
                Early detection and treatment save eyes.  Prevention. New terrapins quarantined 2 weeks.



6. Credits





Around 2 years old. Female. Active terrapin. Excellent shell quality.
Eyes swollen, closed and red for past 3 days.
Lethargic, not eating

Possible causes
1. Bacteria from new terrapin introduced into the tank around 2 weeks ago
2. Pellet quality has deteriorated over the year. Vit A deficiency.
3. De-chlorination chemicals inside the water given daily by the domestic worker.
4. No daily changes of water in the tank.


In-patient treatment at Toa Payoh Vets
Clean water daily. Eye drops and medication.
Eyes open in Day 3 but closed again.
Eyes fully open in Day 4.

Very good chances of success if treatment is given early.
The terrapin did not open her mouth to breathe and so did not have lung infections








Ey

A 7-year-old Shih Tzu cannot control her bladder and passes blood in the urine

> 3 days of haematuria and urinary incontinence. Owner said that this happened after her heat which was 2 weeks ago.

X-rays show no radio-dense urinary stones.

Many older female dogs have urinary tract infections. It could be from continuous licking of the vulva during the heat period as the female dog was cleaning herself. Licking transferred bacteria to the bladder. Spaying when she was younger would have prevented this licking and infection to bladder.

141109. Lymphoma in a Miniature PInscher (2014) and Jack Ruseell (2011)

Saturday Nov 8, 2014

"I notice a large swelling below the right neck," the owner of this 9-year-old female unspayed Miniature Pinscher said.
"Actually, there is another one on the left neck," I examined the active dog that jogs with the owner.
"These are mandibular lymph nodes. The two popliteal lymph nodes behind the knees are much swollen too."


Advised:
TESTS to stage the cancer
1. Biopsy of lymph node
2. CBC (done)
3. serum chemistry profile
4. urinalysis
5. abdominal ultrasound (liver, spleen, intestinal lymph node, internal lymph nodes)
6. chest x-ray (lung, internal lymph nodes, intestinal tract)
7. bone marrow aspirate

Above tests are for STAGING OF LYMPOMA (to search for tumours in other locations)


 BLOOD TEST 2 BY TOA PAYOH VETS ON NOV 9, 2014
Haemoglobin 20  (12-18)
Red cell count 8.8 (5.5-8.5)

Total white cell count 25.3 (6-17)
Neutrophils 24.4% (60-70)    Absolute 6.17 (3-11.5)
Lymphocytes 74.5% (12-30)    Absolute 18.85 (1-4.8)
Monocytes 0.4% (3-10)    Absolute 0.1 (0.15-1.35)
Eosinophils 0.7% (2-10)    Absolute 0.18 (0.1-1.25)
Basophils 0 (rare)    Absolute 0 (rare)

liver and kidneys OK

BLOOD TEST NO. 2 ON NOV 11, 2014
Generalised lymphadenopathy including submandibular, prescap, inguinal and popliateal
Haemoglobin 19.2  (12-18)
Red cell count 8.77 (5.5-8.5)

Total white cell count 21.5 (6-17)
Neutrophils 21% (60-70)    Absolute 4.5 (3-11.5)
Lymphocytes 60% (12-30)    Absolute 12.9 (1-4.8)
Monocytes 18% (3-10)    Absolute 3.8 (0.15-1.35)
Eosinophils 1.2% (2-10)    Absolute 0.25 (0.1-1.25)
Basophils 0.2% (rare)    Absolute 0.05 (rare)

Peripheral blood smear -  shows normochromic normocytic erthroyctes. Mild leucocytosis, lymphocytosis, some reactive lymphocytes seen. Platelets adequate in number. Babesia -ve

FNA popliteal and prescap inconclusive.

Lymph Node excisional biopsy
Cytology (L and R prescap). Smear - mainly small to medium sized lymphocytes. Some lysed cells with no visible cytoplasmic boarder.
(L and R politeal). smears mainly small to medium sized lymphocytes. Some cells with a hand-mirror shape with cytoplasmic pseudopod.

Ultrasound of abdomen - possible liver infiltration. KIV FNA of liver.
X-ray chest - 3 views. No visible enlarged internal lymph node in chest
Urinalysis cystocentesis



pH 5.8 (5.5-8.5), SG 1.020 (1.015 - 1.045). Occasional RBC, WBC, epithelial cells, bacteria. Crystals variable.
creatinine, albumin, total protein tests


TENTATIVE DIAGNOSIS
Lymphoma

CAUSE - Unknown. Old age.


5 FORMS
1. External lymph nodes
2. Gastrointestinal tract
3. Mediastinal
4. Skin
5. Bone marrow

TREATMENT
Expensive. IV chemotherapy.
Remission. Recurrence. Most dogs after chemotherapy live for around one year if there is no recurrence.

REFERENCE:
http://www.vet.purdue.edu/pcop/canine-lymphoma-research.php


--------------------------------------------------------
LYMPHOMA IN A JACK RUSSELL IN 2011

Monday, March 28, 2011

378. Sunday Case. "My Jack Russell suddenly can't see"

I HOPE THIS REAL CASE WILL HELP THE 5TH YEAR VET STUDENT WITH THOUSANDS OF SUBJECTS TO REMEMBER AND BE EXAMINED BEFORE GRADUATION!

One look from my reception counter and I could see that this Jack Russell was suffering from Canine Lymphosarcoma. Some vets prefer to call it Canine Lymphoma. The two lumps of the size of ping-pong balls on the right and left lower jaws were too obvious to miss.

The owners were a young couple in their early 30s and an older woman and there was great emotions involved. The mum was distressed that the 8-year-old male Jack Russell walked into chairs and just could not see on this fine Sunday morning. Only the day before, the dog was zipping here and there when exercised outdoors. No accidents. No falls. No injuries. The dog just couldn't see! Why? What happened?

I decided to handle this case as the leading vet responsible for the outcome and together with my associate vet. Working as a team is a pleasure of veterinary medicine as we share our workload. I asked if she objected as she was on duty, but this was not her client. My associate said: "I am OK."

HISTORY
"What did Vet 1 say?" I asked when the owner showed me the report of a pre-scapular lymph node biopsy sent to the AVA lab.
"Vet 1 said that the AVA lab cannot confirm that the dog is suffering from lymphoma."

I read the report. It stated that it needed at least 2 biopsies from 2 lymph nodes and to relate to clinical signs. The presented biopsy cells could not confirm lymphoma.

So the owners must have concluded that the dog was not suffering from lymphoma!
No further treatment.

EYES
Blood inside both eyes preventing vision.
Note: In canine lymphoma, eye involved in 25% of cases). This can lead to bleeding within the eye, uveitis, glaucoma, retinal detachment and blindness.)

BLOOD TEST RESULTS OF DOG WITH LYMPHOMA OVER AT LEAST 1 MONTH
I was checking for infection (high WCC) or immune suppression (low WCC and platelets) or cancer (e.g. leukaemia with very high WCC), liver and kidney disorder.

Results are as follows:
Haemoglobin 13.9 (12-18)
Total WCC 11.8 (6-17)
Neutrophils 70.51 Abs 8.32
Lymphocytes 16.44 Abs 1.94
Monocytes 11.19 Abs 1.32
Eosinophils 0.09 Abs 0.01
Basophils 1.95 Abs 0.23

Red cell count 5.5 (5.5-8.5)
PCV 0.38 (0.37-0.55)
MCV 69 (60-77)
MCH 25 (20-25)
MCHC 36 (32-36)
RDW 14.1%

Platelets 90* (200-500). No platelet clumps seen.

LIVER PROFILE
ALT/SGPT 169 (<59 -3.6="" -="" 0.05="" 0.1="" 0.2="" 1.="" 138="" 2.58="" 2.="" 2="" 3.="" 4.="" 4047="" 4049.="" 4a="" 54="" 5a="" 5b="" 6.3="" 7="" 8.3="" a="" abdomen.="" abdominal="" acid="" active.="" acute="" affecting="" anaemia="" and="" anterior="" as="" asked="" ast="" be="" became="" been="" bite="" bleeding.="" bleeding="" blood="" bone="" both="" but="" bw.="" calcium="" canine="" cases="" causing="" cells="" central="" chemotherapy.="" chemotherapy="" class="separator" cost="" could="" count="" counts="" creatinine="" cure="" day="" decide="" depend="" depends="" developing="" did="" disease="" div="" do="" dog.="" dog="" domitor="" dose.="" drugs.="" due="" eating.="" eating="" enlarged.="" enlarged="" experience="" eye="" eyes.="" eyes="" for="" free="" from="" function="" generalised="" give="" guideline.="" had="" happened="" has="" highly="" his="" how="" hunched="" i="" impressed="" in="" infections.="" inside="" intense="" into="" involvement="" is="" it="" iv.="" ketamine="" kg.="" kidney="" life="" live="" liver="" long="" low="" lowest="" lymph="" lymphoma.="" lymphoma="" marrow="" may="" me.="" me="" means="" mild="" ml="" monitoring.="" months="" my="" nervous="" next="" no.="" no="" node="" nodes="" normal="" normally.="" not="" now="" of="" on="" one="" or="" other="" owner="" owners="" pacing="" pain="" palpated="" pancreatitis="" permanent="" platelet="" present="" problem="" profile="" prolonging="" quite="" quoted="" reading="" red="" relieve="" remission="" reports.="" reports="" risky="" rom="" rubbed="" rubs="" s="" said="" sclera="" sedation="" see.="" see="" seizures="" several="" shows="" situation.="" slept.="" solve="" some="" spleen="" stage="" stopped="" style="clear: both; text-align: center;" sunday="" syringe="" system="" tage="" test="" the="" there="" this="" to="" treatment.="" treatment="" two="" type="" urea="" uric="" varies="" very="" vet="" vigorously="" vision="" was="" were="" what="" whether="" which="" white="" will="" with="" without="" would="" yet="">

Posted by Be Kind To Pets at 4:26 PM

A wedding promise

A Myanmar lady getting married to a Spanish man today asked me to edit her speech at the wedding.

HER VOWS

First I want to say thanks you.. to my groom as you make my dreams come true. I am proud to be your wife and join my life with yours.

I promise to love and care for you and I will try in every way to be worthy of your love.

And wherever our journey leads us, living, learning and loving together for 2000 years.

 -------------------------------
 MY SUGGESTION 

Today is my most important and happiest day of my life as I stand beside my beloved man of my dreams to exchange rings and promises.

Today, we begin a new journey that I pray will be filled with love, care and learning about each other till the end of our lives.

I promise to love and care for you in good times and in bad times, in health and in sickness, with joys and laughter, as we grow old together, as the dream girl you have married today.

I hope we can be forever as one united from today, till our hairs turn silver, still in love in our winter years.