A 13-year-old Silkie has sticky right eye discharge everyday for several months.
"Dr
E prescribed eye drops and eye ointment and they were effective for
some time," the wife took out the bottles from the plastic bag and put
on my consultation table. "After a while, they don't work and I went to
the pet shop to buy the eye drops. I don't want the same eye medication
from you."
17. How to take care of your old dog's eye (Video)
Surprisingly,
the left eye cornea was as clear as a crystal but the right eye cornea
was scarred with brown dots of pigments covering 80% of the surface. The
eye white was reddish as compared to the normal white of the left eye.
"Has the dog been rubbing his right eye with his right hind leg daily?" I asked.
"Yes, yes," the husband said.
I applied fluorescein eye drops onto the cornea (video) and there was no ulcerations as there was no green stain.
"The
brown pigments on the right eye cornea are caused by long-time
scratching and now is scarred," I said. "There is no chance of reverting
to the clear cornea. Now, we need to prevent the 20% of the cornea from
becoming covered up with brown pigmentation."
"The
possible causes could be the right ear pain as the dog wanted to snap at
me when I palpated the ear. Another cause could be tooth ache as the
roots of the back upper teeth are exposed and the teeth are cemened with
thick tartar," I explained to the owners.
Sedation 5 kg, 13-year-old Silkie: Domitor + Ketamine 0.05 + 0.05 ml IV
Ear irrigation
Eye irrigation with 3rd eyelid everted to flush out debri
Optomimmune and eye drops. E-collar.
Inj. antibiotic and anti-inflam.
E-collar for 2 months.
To review in 3 weeks and dental scaling.
CONCLUSION
Allergy
to commercial ear drops, vigorous overcleaning of the right ear and
periodontal diseases can cause ear scratching with collateral damage to
the right eye in this case. Early dental scaling would have been
preferred.
Tuesday, May 19, 2015
2157. The old German Shepherd is scratching furiously
Monday, March 18, 2015
After 2 days of scratching from nose to paws, the owner phoned me for help. The 2nd sister had given this dog a piece of chicken on Mother's Day and now the dog keeps scratching her body.
She was fed only meat and rice nowadays and was all right. If fed commercial dog food, she would have diarrhoea and itchy body.
This old German Shepherd has bad hips and could not stand up if the carprofen injection under the skin is not given every 2 weekly. She got this injection from another vet every 2 weeks, not wanting to bother me. Lately she had her cataract operation on one eye first. As the surgeon had been on medical leave, after operating on 150 cases in one day, she saw her relief surgeon. She was a popular in great demand surgeon and had to take leave. So she packed the previous day's cases to the next day, totalling 150 cataract operations.
The relief surgeon read her medical notes and said: "It is lucky that you had opted for the mono-foal lens instead of the multi-focal as you have scars in your retina."
However, the surgeon had actually recommended multi-focal lens and she had accepted this advice. In multi-focal lens, you don't need reading spectacles. However, 3 days before the surgery, we went to my family optician, an experienced man in his 50s. He said: "Some of the people having multi-focal lens suffered side effects of seeing flashing lights and get depressed. There is no cure for this. Taking out the multi-focal lens and replacing a mono-focal is not that easy as in the first implant. With mono-focal, you need to have prescription lenses to read but you don't have these flashing lights."
So, this owner was very unhappy with the surgeon.
After 2 days of scratching from nose to paws, the owner phoned me for help. The 2nd sister had given this dog a piece of chicken on Mother's Day and now the dog keeps scratching her body.
She was fed only meat and rice nowadays and was all right. If fed commercial dog food, she would have diarrhoea and itchy body.
This old German Shepherd has bad hips and could not stand up if the carprofen injection under the skin is not given every 2 weekly. She got this injection from another vet every 2 weeks, not wanting to bother me. Lately she had her cataract operation on one eye first. As the surgeon had been on medical leave, after operating on 150 cases in one day, she saw her relief surgeon. She was a popular in great demand surgeon and had to take leave. So she packed the previous day's cases to the next day, totalling 150 cataract operations.
The relief surgeon read her medical notes and said: "It is lucky that you had opted for the mono-foal lens instead of the multi-focal as you have scars in your retina."
However, the surgeon had actually recommended multi-focal lens and she had accepted this advice. In multi-focal lens, you don't need reading spectacles. However, 3 days before the surgery, we went to my family optician, an experienced man in his 50s. He said: "Some of the people having multi-focal lens suffered side effects of seeing flashing lights and get depressed. There is no cure for this. Taking out the multi-focal lens and replacing a mono-focal is not that easy as in the first implant. With mono-focal, you need to have prescription lenses to read but you don't have these flashing lights."
So, this owner was very unhappy with the surgeon.
Sunday, May 17, 2015
2156. Third opinion. The stench of covered armpit wounds in a 16-year-old dog
Sunday May 17, 2015
The 16-year-old Maltese was afraid of me examining the wound, despite being given Tramadol painkiller tablets by Vet 2, 4 days ago. I was unwrapping the elastoplast and yellow wrap around self-adhering bandages covering the long left armpit wound. As I unrolled the bandage, the smell of rotting flesh permeated the consultation room.
"Vet 2 had given an antibiotic injection guaranteed to last 2 weeks," the young lady owner said. "So, he only prescribed the Tramadol, 1/2 tablet 2 times a day."
"Was Tramadol effective?" I asked.
"Yes," she confirmed that the dog was walking around when given the medication.
The dark greenish stained gauze under the bandage gave off an offensive odour of dead meat. I tried to control my breath. It is an odour of decomposed egg few Singaporeans will ever smell. It glued onto my fingers and needed several hand shampoos to get rid of the smell.
Vet 1 had prescribed some antibiotics and cleanser but this did not work. The dog's armpit got infected. So Vet 2 bandaged the leg from the wrist upward and adduct the armpit closer to the body with Elastoplast. The owner must return every 3 days to get the bandage changed. The owner sought me as the 3rd opinion.
The dog was practically screaming when I slowly unwrapped the bandage. He had a high tolerance to pain and had taken half a tablet of a 50-mg Tramadol.
"There's no choice but to sedate him to clean up the bad smelly armpit wound," I told the owners. "When a wound is covered up, it becomes smelly as a different type of bacteria thrives and grow in the flesh. It is highly risky as he may die. I will give a very low dose."
I can understand that Vet 1 and Vet 2 do not want to take risk in anaesthesizing this old dog to stitch up the wound. It is a thankless option if the dog dies. Some owners just blame the vets when the dog dies, implying negligence and incompetence.
I gave Domitor and Ketamine at 10% of the normal dosage IV. The dog slept for less than 10 minutes and the armpit wound was flushed and irrigated. The dog was shampooed. I applied KMnO4 powder, injected antibiotics and inflammatory and the dog was sent home.
The 16-year-old Maltese was afraid of me examining the wound, despite being given Tramadol painkiller tablets by Vet 2, 4 days ago. I was unwrapping the elastoplast and yellow wrap around self-adhering bandages covering the long left armpit wound. As I unrolled the bandage, the smell of rotting flesh permeated the consultation room.
"Vet 2 had given an antibiotic injection guaranteed to last 2 weeks," the young lady owner said. "So, he only prescribed the Tramadol, 1/2 tablet 2 times a day."
"Was Tramadol effective?" I asked.
"Yes," she confirmed that the dog was walking around when given the medication.
The dark greenish stained gauze under the bandage gave off an offensive odour of dead meat. I tried to control my breath. It is an odour of decomposed egg few Singaporeans will ever smell. It glued onto my fingers and needed several hand shampoos to get rid of the smell.
Vet 1 had prescribed some antibiotics and cleanser but this did not work. The dog's armpit got infected. So Vet 2 bandaged the leg from the wrist upward and adduct the armpit closer to the body with Elastoplast. The owner must return every 3 days to get the bandage changed. The owner sought me as the 3rd opinion.
The dog was practically screaming when I slowly unwrapped the bandage. He had a high tolerance to pain and had taken half a tablet of a 50-mg Tramadol.
"There's no choice but to sedate him to clean up the bad smelly armpit wound," I told the owners. "When a wound is covered up, it becomes smelly as a different type of bacteria thrives and grow in the flesh. It is highly risky as he may die. I will give a very low dose."
I can understand that Vet 1 and Vet 2 do not want to take risk in anaesthesizing this old dog to stitch up the wound. It is a thankless option if the dog dies. Some owners just blame the vets when the dog dies, implying negligence and incompetence.
I gave Domitor and Ketamine at 10% of the normal dosage IV. The dog slept for less than 10 minutes and the armpit wound was flushed and irrigated. The dog was shampooed. I applied KMnO4 powder, injected antibiotics and inflammatory and the dog was sent home.
2155. Ozone-oil treatment for all types of illnesses?
Saturday May16, 2015
I had breakfast on this sunny blue-sky Saturday morning with a senior vet. There was a Caucasian vet who came to Singapore to buy veterinary practices and I advised him to sell his practice. "The general offer is 3 times the annual revenue, subject to negotiations," I had read about this in some financial books and this Caucasian vet had also mentioned this formula to me.
This senior vet has a new product - an ozone-oil said to be very good for coughs, diarrhoea, skin wounds and many illnesses. In one case, the puppies with diarrhoea recovered after being given this product. "However, the breeder did not get the same outcome when the puppies had diarrhoea again," he laughed. His hypothesis is that antibiotics are specific for some types of bacteria like gram +positive only. But his ozone-oil, like the freshness of the air around sea waves, kills all bacteria, yeasts, viruses and other pathogens.
I had no comments. "If your product can heal wounds within 2 days, you have a big market with the construction workers," I said. "They suffer from cuts at work and coughing from hard work. Your product will say like hot cakes."
I had breakfast on this sunny blue-sky Saturday morning with a senior vet. There was a Caucasian vet who came to Singapore to buy veterinary practices and I advised him to sell his practice. "The general offer is 3 times the annual revenue, subject to negotiations," I had read about this in some financial books and this Caucasian vet had also mentioned this formula to me.
This senior vet has a new product - an ozone-oil said to be very good for coughs, diarrhoea, skin wounds and many illnesses. In one case, the puppies with diarrhoea recovered after being given this product. "However, the breeder did not get the same outcome when the puppies had diarrhoea again," he laughed. His hypothesis is that antibiotics are specific for some types of bacteria like gram +positive only. But his ozone-oil, like the freshness of the air around sea waves, kills all bacteria, yeasts, viruses and other pathogens.
I had no comments. "If your product can heal wounds within 2 days, you have a big market with the construction workers," I said. "They suffer from cuts at work and coughing from hard work. Your product will say like hot cakes."
2154. The Schnauzer's groomer is more important than the vet
Saturday Mar 16, 2015
Today was a busy Saturday. Dr Daniel had gone to Bangkok for a seminar and I was the only vet seeing cases. I was surprised to see this 10-year-old Miniature Schnauzer as the owner had not bothered to bring him for an annual vaccination and check up. The dog goes to the groomer every 2 monthly or so.
The dog was itchy and kept scratching his ears and body. So, the mistress came to see me. "He bites and will not be muzzled," she said. "He was whining in the car as I drove nearer to your clinic. Whenever he bites he paws, I will say 'Dr Sing' and he would stop. However, he would still bite his paws when I am not around."
I had seen this dog as a puppy and had seen him for the first 6 years at least once. As the mistress got promoted, she had to travel a lot for meetings in Germany and so she did not spend any time to bring the dog in for his annual check up or vaccination. The groomer's appointments were kept. Many owners doctor hop and so it was most surprising when I saw her after 4 years.
Health screening or wellness care once a year including physical examination, blood and urine tests and dental check ups will detect any diseases early so that the dog can live longer.
Case 2.
A young lady who returned home from overseas phoned to say her Cocker Spaniel had fits suddenly. She booked dog transport and came to see me. "Rotten teeth and painful ear infections can cause fits," I said to her. The dog was 12 years old and the teeth were all black. In some cases, just removing the painful decaying teeth would have improved the health of the older dog. But many owners in Singapore just do not have time or inclination to send the dog for dental check up at the vet. Some dog groomers provide such a service and so, the groomer is more important than the vet. Till the dog has serious illness and in this case, the vet is needed!
Today was a busy Saturday. Dr Daniel had gone to Bangkok for a seminar and I was the only vet seeing cases. I was surprised to see this 10-year-old Miniature Schnauzer as the owner had not bothered to bring him for an annual vaccination and check up. The dog goes to the groomer every 2 monthly or so.
The dog was itchy and kept scratching his ears and body. So, the mistress came to see me. "He bites and will not be muzzled," she said. "He was whining in the car as I drove nearer to your clinic. Whenever he bites he paws, I will say 'Dr Sing' and he would stop. However, he would still bite his paws when I am not around."
I had seen this dog as a puppy and had seen him for the first 6 years at least once. As the mistress got promoted, she had to travel a lot for meetings in Germany and so she did not spend any time to bring the dog in for his annual check up or vaccination. The groomer's appointments were kept. Many owners doctor hop and so it was most surprising when I saw her after 4 years.
Health screening or wellness care once a year including physical examination, blood and urine tests and dental check ups will detect any diseases early so that the dog can live longer.
Case 2.
A young lady who returned home from overseas phoned to say her Cocker Spaniel had fits suddenly. She booked dog transport and came to see me. "Rotten teeth and painful ear infections can cause fits," I said to her. The dog was 12 years old and the teeth were all black. In some cases, just removing the painful decaying teeth would have improved the health of the older dog. But many owners in Singapore just do not have time or inclination to send the dog for dental check up at the vet. Some dog groomers provide such a service and so, the groomer is more important than the vet. Till the dog has serious illness and in this case, the vet is needed!
2153. How your dog can live longer - Recurring kidney stones in a 12-year-old poodle
Kidney stones do occur in dogs. In this 10-year-old poodle, they were small specks of kidney stones seen in the X-rays in 2013. I had removed the bladder stones and had advised that the minor struvite kidney stones could be dissolved with prescription S/D diet over 1-3 months. Regular urine tests, blood tests and X-rays needed to be done to ensure that the stones had been completely eliminated.
However, the owners did not return for follow ups over the next two years. Nor did they come for annual check ups. They fed brown rice and minced beef mainly.
In 2015, they came as the poodle was passing blood in the urine. She had extremely painful kidneys and the left kidney stones had become gigantic as can be seen in the 2015 X-rays.
Blood test indicated kidney failure. The dog could have lived longer if she had been fed the S/D diet till the stones dissolved from 1-3 months.
This poodle was euthanased. I hope thiscase study may save lives of dogs in a similar situation with small specks of struvite kidney stones. Struvites can be dissolved by dietary management. Regular monitoring over the year is necessary.
Friday, May 15, 2015
2152. A good mother brings a child's hamster for treatment. A good father could have bought a tankful of terrapins
May 15, 2015
The storm clouds were gathering. I was teaching my intern Sue how to take care of the vertical ear canal ablation Schnauzer in-patient for 3 days. Yesterday, I had sedated the dog and Naing had cleaned up the blood clots. There was some bleeding (see video) and I made a video on how to do the nursing part.
At around 10 am, a mother came in with a dwarf hamster. He has a left swollen eyelid just like the other hamster with ear warts. She had texted me and emailed me for an appointment. This is her child's beloved pet and she took the trouble to contact me and come early.
I was also treating a terrapin that had closed and swollen eyes for over 7 weeks. "With the money I spent on vet fees," the father said. "I could have bought a tank full of terrapins!"
He was a dynamic man in his 30s sending out strong vibes as I asked him about executive condos and HDB apartments for sale. He had brought the terrapin to see Dr Daniel 3 weeks ago but was unable to medicate the terrapin.
Well, at $5.00 per hatchling, he could have bought 50 terrapins and discard this sick emaciated one weighing 16 g now. Definitely a tankful. But I don't think his son has the same point of view as the father.
ISOFLURANE + O2 ANAESTHESIA
5% for around 45 seconds. Hamster had an upper eyelid abscess of the right eye and gigantic lower eyelid abscess of the left eye (video). Quick lancing, drainage with cotton bud tip and finger expression, lavage incised wound with water within 20 seconds as the hamster wakes up.
My intern decided to adjust the operation light at the ending of the operation which made me quite mad as the video could not be completed entirely. While her hands were adjusting the operating lights, she could not film and by the time she could film, I had completed my operation.
Many young people do not comply with instructions.
A good mother brings a child's hamster for treatment without bean-counting.
A good father could have bought a tankful of terrapins if not for his son's love for the sick terrapin.
The storm clouds were gathering. I was teaching my intern Sue how to take care of the vertical ear canal ablation Schnauzer in-patient for 3 days. Yesterday, I had sedated the dog and Naing had cleaned up the blood clots. There was some bleeding (see video) and I made a video on how to do the nursing part.
At around 10 am, a mother came in with a dwarf hamster. He has a left swollen eyelid just like the other hamster with ear warts. She had texted me and emailed me for an appointment. This is her child's beloved pet and she took the trouble to contact me and come early.
I was also treating a terrapin that had closed and swollen eyes for over 7 weeks. "With the money I spent on vet fees," the father said. "I could have bought a tank full of terrapins!"
He was a dynamic man in his 30s sending out strong vibes as I asked him about executive condos and HDB apartments for sale. He had brought the terrapin to see Dr Daniel 3 weeks ago but was unable to medicate the terrapin.
Well, at $5.00 per hatchling, he could have bought 50 terrapins and discard this sick emaciated one weighing 16 g now. Definitely a tankful. But I don't think his son has the same point of view as the father.
ISOFLURANE + O2 ANAESTHESIA
5% for around 45 seconds. Hamster had an upper eyelid abscess of the right eye and gigantic lower eyelid abscess of the left eye (video). Quick lancing, drainage with cotton bud tip and finger expression, lavage incised wound with water within 20 seconds as the hamster wakes up.
My intern decided to adjust the operation light at the ending of the operation which made me quite mad as the video could not be completed entirely. While her hands were adjusting the operating lights, she could not film and by the time she could film, I had completed my operation.
Many young people do not comply with instructions.
A good mother brings a child's hamster for treatment without bean-counting.
A good father could have bought a tankful of terrapins if not for his son's love for the sick terrapin.
Tuesday, May 12, 2015
An old cat has painful kidneys - illustration for children's story
May 12, 2015
PATIENT
Fatty, Female, Spayed cat, 10 years old
Adopted by a young lady in her 20s.
The young lady studies for an illustration diploma. I asked her to illustrate her old cat's veterinary journey. She came today to buy a carton of feline k/d after I told her not to feed the usual cat food first as the kidneys were very painful when I checked the cat on April 29, 2015.
At that time, the cat came in as she was not eating and drinking for 3 days. she had diarrhoea for 4 days and passed dark choocolate-coloured stools. He had fever of 40.5 degrees C and also enlarged submandibular lymph nodes.
When I palpated the kidneys, the cat growled.
"The kidneys are enlarged," I advised X-rays which showed the enlargement.
Blood tests to check the health of the kidneys were not done to lower medical costs. However, in Mar 7, 2015, the cat had been vomiting every "2nd day" for the last 7 days. The kidneys were painful. The cat had ductal carcinoma of the left breast MG1 and enlarged left axillary lymph node. The breast lump was excised by Dr Daniel on Feb 15, 2015 and histology confirmed the malignant ductal carcinoma.
In January 31, 2015, the cat had dental work done and ears cleaned. The left lower canine tooth was decayed and extracted. The large left breast tumour 3 cm x 3cm was seen and surgery scheduled in Feb 15, 2015.
The stray cat could be 10 years old and had probably been abandoned. She was adopted by the young lady and treated since Jan 31, 2015.
Blood tests done on Feb 2, 2015.
No kidney disorder. Low platelets of 60 (300-800)
Blood tests done on Mar 8, 2015
No kidney disorder
Total white cell count was 2.3 (5-5 - 19.5) with neutrophils 24% (60-70%) and absolute at 0.55 (3-11.5).
Platelets were low at 78 (300-800).
Tiger Balm medication could have been licked by the cat. There was kidney pain in Mar and April 2015.
Kidney X-rays were done in April 29, 2015.
After IV drips and antibiotics, the cat was sent home with special diet feline K/D.
"Add the K/D to existing canned food bit by bit," I said to the young lady. The cat will not eat K/D which is meant for kidney diseases immediately.
Within a week, the cat was eating 1/2 can of K/D. Yesterday, the owner wanted to switch her entirely to the original canned food. However I did not re-examine the cat or has her urine to analyse for protein, bacteria, white cells and other abnormalities. I advised a month of K/D first and so she came to buy 24 cartons of the food.
The young lady said the cat was OK and wanted to switch to normal canned food.
PATIENT
Fatty, Female, Spayed cat, 10 years old
Adopted by a young lady in her 20s.
The young lady studies for an illustration diploma. I asked her to illustrate her old cat's veterinary journey. She came today to buy a carton of feline k/d after I told her not to feed the usual cat food first as the kidneys were very painful when I checked the cat on April 29, 2015.
At that time, the cat came in as she was not eating and drinking for 3 days. she had diarrhoea for 4 days and passed dark choocolate-coloured stools. He had fever of 40.5 degrees C and also enlarged submandibular lymph nodes.
When I palpated the kidneys, the cat growled.
"The kidneys are enlarged," I advised X-rays which showed the enlargement.
Blood tests to check the health of the kidneys were not done to lower medical costs. However, in Mar 7, 2015, the cat had been vomiting every "2nd day" for the last 7 days. The kidneys were painful. The cat had ductal carcinoma of the left breast MG1 and enlarged left axillary lymph node. The breast lump was excised by Dr Daniel on Feb 15, 2015 and histology confirmed the malignant ductal carcinoma.
In January 31, 2015, the cat had dental work done and ears cleaned. The left lower canine tooth was decayed and extracted. The large left breast tumour 3 cm x 3cm was seen and surgery scheduled in Feb 15, 2015.
The stray cat could be 10 years old and had probably been abandoned. She was adopted by the young lady and treated since Jan 31, 2015.
Blood tests done on Feb 2, 2015.
No kidney disorder. Low platelets of 60 (300-800)
Blood tests done on Mar 8, 2015
No kidney disorder
Total white cell count was 2.3 (5-5 - 19.5) with neutrophils 24% (60-70%) and absolute at 0.55 (3-11.5).
Platelets were low at 78 (300-800).
Tiger Balm medication could have been licked by the cat. There was kidney pain in Mar and April 2015.
Kidney X-rays were done in April 29, 2015.
After IV drips and antibiotics, the cat was sent home with special diet feline K/D.
"Add the K/D to existing canned food bit by bit," I said to the young lady. The cat will not eat K/D which is meant for kidney diseases immediately.
Within a week, the cat was eating 1/2 can of K/D. Yesterday, the owner wanted to switch her entirely to the original canned food. However I did not re-examine the cat or has her urine to analyse for protein, bacteria, white cells and other abnormalities. I advised a month of K/D first and so she came to buy 24 cartons of the food.
The young lady said the cat was OK and wanted to switch to normal canned food.
Monday, May 11, 2015
2150. A female Miniature Schnauzer has bladder stones packed to the gills again
May 11, 2015
Another case of recurrent struvite bladder stones 19 months after removal by Dr Daniel in Oct 3, 2013. This 5-year-old female Miniature Schnauzer has bladder stones packed to the gills.
Schnauzers have a familiar tendency to develop urinary stones and owners need to monitor the urine and do X-rays regularly to prevent recurrence.
Nearly 100% of the Schnauzer owners do not bother to come for regular monitoring and they either put the dog to sleep, get the dog operated again. But some kidney stones are inoperable as the dog also has septicaemia and kidney failure.
Images of today's surgery for this female Schnauzer are:
-------------------------------------------------------------------------
FLASH BACK TO OCT 2013 FIRST SURGERY RECORDED IN BLOG NO. 1173
"The urine test on Oct 2, 2013 shows the presence of occasional numbers of calcium oxalate and triple phosphate crystals," Dr Daniel said to me when I asked him about the urine test after he had completed the bladder stone removal surgery. He could see that the few numbers of crystals in the urine does not co-relate with the number of formed stones which exceeded 20 big and small ones in this case. "Absence of crystals in the urine" does not mean there is no bladder stone. X-rays will be best.
Each vet has his own approach to this type of surgery. He had injected saline into the bladder to check for leaks and there was none. "A fine needle was used," he said to me. I am aware of this way of checking for leakage. Usually I inject saline via the urinary cathether in the female dog.
I did a video of the stones being taken out as there were numerous. I had done videos of bladder stone removal and so I do not video this type of surgery as it takes a lot of time to produce a video.
AUDIT OF THIS CASE
tp 42373
Miniature Schnauzer, White, Female, 3 years old. Born Nov 4, 2010.
Significant time-lines
Feb 24, 2012. I spayed the dog. Uterus was enlarged but not from pregnancy. Blood test normal.
Nov 30, 2012. Blood in the urine. I advised urine test and no dry food. Urinary tract infection.
Jul 14, 2013. During annual vaccination, I palpated the bladder and felt "crepitus" - feeling of gas and bladder stones rubbing against each other inside the bladder. I advised X-rays as I was quite sure these were bladder stones.
Interestingly, I recorded the following 4 words "Dr Daniel said no." I had asked his opinion and he had palpated the bladder. Sometimes I would be present during his consultations as a mentor.
Every vet has his or her own opinions and each vet, after palpation of the bladder may give different points of view as in this case and that does not reflect on the vet's competence. X-rays will be most helpful but the owner came for vaccination and not for urinary tract problems like blood in the urine.
Oct 1, 2013. Dr Daniel was consulted for decreased in appetite of the dog and vomiting of digested food. He advised X-rays and urine tests. Urine tests showed pH 8.0, USG 1.020, bacteria 3+, blood 4+, calcium oxalate and triple phosphate occasional.
X-rays showed numerous large stones. Dr Daniel opened up the bladder and removed the stones.
FOLLOW UP WITH OWNER ON OCT 3, 2013.
The owner said that he had given canned food since my advice to cut out the dry food in Nov 2012. He said that his relative's Shih Tzu called Mikki also had similar problems and eating the same brand of wet food called "Burp". I remember Mikki. He had difficulty in urination and urine tests showed triple phosphate. X-rays showed no stones and the dog is on S/D diet for the time being till the urine test is negative.
It is important to follow up with the owner but this takes time and some vets may not want to do it. As to what to do now after the operation, the stone analysis will need to be known first. From appearance, I would say they are struvite stones. S/D canned diet for 1-3 months and urine test 3 monthly will be my advice but many owners have their own ideas.
It is my opinion that the stones were formed much earlier and the changing to "Burp" canned food was too late and probably does not contribute to the struvite stone formation unless it alkalinises the urine. The bacterial infection of the bladder in an alkaline urine causes triple phosphates and struvites to form. It is inconclusive evidence that "Burp" cause the formation of stones.
"Miniature Schnauzers are one breed famous for bladder stones," I said to the owner.
Circumstantial evidence of "Burp" causing bladdder stones in this Schnauzer is made because Mikki had similar difficulty in urination problems too when fed on "Burp". But no stones were seen in Mikki's X-rays. I remember this Mikki very well since this Shih Tzu's owner had two episodes of urination difficulties in Mikki. In the 2nd episode, the couple had the X-rays done and no stones were seen. Now the dog is on S/D diet and so far, no more dysuria problems. Mikki is another story.
FOLLOW UP ON OCT 7, 2013 BY PHONE AT 8.05 pm, 5 days post-removal of bladder stones by Dr Daniel.
Owner is satisfied today as the dog is active, eats and drinks. Urine no blood. Stools normal.
--------------------------------------------------
UPDATE IN MAY 12, 2015
The owner did not come back for check up or follow up since the first surgery done in Oct 2013. The stone analysis reveal MAP (Magnesium, Aluminium, Phosphate) and Calcium. Yesterday, the dog was operated and more than 40 large stones and a hundred small ones were removed from the bladder. The kidneys do not have any stones. See top of page for latest information.
Another case of recurrent struvite bladder stones 19 months after removal by Dr Daniel in Oct 3, 2013. This 5-year-old female Miniature Schnauzer has bladder stones packed to the gills.
Schnauzers have a familiar tendency to develop urinary stones and owners need to monitor the urine and do X-rays regularly to prevent recurrence.
Nearly 100% of the Schnauzer owners do not bother to come for regular monitoring and they either put the dog to sleep, get the dog operated again. But some kidney stones are inoperable as the dog also has septicaemia and kidney failure.
Images of today's surgery for this female Schnauzer are:
-------------------------------------------------------------------------
FLASH BACK TO OCT 2013 FIRST SURGERY RECORDED IN BLOG NO. 1173
Wednesday, October 2, 2013
1173. Audit: A young Miniature Schnauzer has a bladder full of big stones
"The urine test on Oct 2, 2013 shows the presence of occasional numbers of calcium oxalate and triple phosphate crystals," Dr Daniel said to me when I asked him about the urine test after he had completed the bladder stone removal surgery. He could see that the few numbers of crystals in the urine does not co-relate with the number of formed stones which exceeded 20 big and small ones in this case. "Absence of crystals in the urine" does not mean there is no bladder stone. X-rays will be best.
Each vet has his own approach to this type of surgery. He had injected saline into the bladder to check for leaks and there was none. "A fine needle was used," he said to me. I am aware of this way of checking for leakage. Usually I inject saline via the urinary cathether in the female dog.
I did a video of the stones being taken out as there were numerous. I had done videos of bladder stone removal and so I do not video this type of surgery as it takes a lot of time to produce a video.
AUDIT OF THIS CASE
tp 42373
Miniature Schnauzer, White, Female, 3 years old. Born Nov 4, 2010.
Significant time-lines
Feb 24, 2012. I spayed the dog. Uterus was enlarged but not from pregnancy. Blood test normal.
Nov 30, 2012. Blood in the urine. I advised urine test and no dry food. Urinary tract infection.
Jul 14, 2013. During annual vaccination, I palpated the bladder and felt "crepitus" - feeling of gas and bladder stones rubbing against each other inside the bladder. I advised X-rays as I was quite sure these were bladder stones.
Interestingly, I recorded the following 4 words "Dr Daniel said no." I had asked his opinion and he had palpated the bladder. Sometimes I would be present during his consultations as a mentor.
Every vet has his or her own opinions and each vet, after palpation of the bladder may give different points of view as in this case and that does not reflect on the vet's competence. X-rays will be most helpful but the owner came for vaccination and not for urinary tract problems like blood in the urine.
Oct 1, 2013. Dr Daniel was consulted for decreased in appetite of the dog and vomiting of digested food. He advised X-rays and urine tests. Urine tests showed pH 8.0, USG 1.020, bacteria 3+, blood 4+, calcium oxalate and triple phosphate occasional.
X-rays showed numerous large stones. Dr Daniel opened up the bladder and removed the stones.
FOLLOW UP WITH OWNER ON OCT 3, 2013.
The owner said that he had given canned food since my advice to cut out the dry food in Nov 2012. He said that his relative's Shih Tzu called Mikki also had similar problems and eating the same brand of wet food called "Burp". I remember Mikki. He had difficulty in urination and urine tests showed triple phosphate. X-rays showed no stones and the dog is on S/D diet for the time being till the urine test is negative.
It is important to follow up with the owner but this takes time and some vets may not want to do it. As to what to do now after the operation, the stone analysis will need to be known first. From appearance, I would say they are struvite stones. S/D canned diet for 1-3 months and urine test 3 monthly will be my advice but many owners have their own ideas.
It is my opinion that the stones were formed much earlier and the changing to "Burp" canned food was too late and probably does not contribute to the struvite stone formation unless it alkalinises the urine. The bacterial infection of the bladder in an alkaline urine causes triple phosphates and struvites to form. It is inconclusive evidence that "Burp" cause the formation of stones.
"Miniature Schnauzers are one breed famous for bladder stones," I said to the owner.
Circumstantial evidence of "Burp" causing bladdder stones in this Schnauzer is made because Mikki had similar difficulty in urination problems too when fed on "Burp". But no stones were seen in Mikki's X-rays. I remember this Mikki very well since this Shih Tzu's owner had two episodes of urination difficulties in Mikki. In the 2nd episode, the couple had the X-rays done and no stones were seen. Now the dog is on S/D diet and so far, no more dysuria problems. Mikki is another story.
FOLLOW UP ON OCT 7, 2013 BY PHONE AT 8.05 pm, 5 days post-removal of bladder stones by Dr Daniel.
Owner is satisfied today as the dog is active, eats and drinks. Urine no blood. Stools normal.
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UPDATE IN MAY 12, 2015
The owner did not come back for check up or follow up since the first surgery done in Oct 2013. The stone analysis reveal MAP (Magnesium, Aluminium, Phosphate) and Calcium. Yesterday, the dog was operated and more than 40 large stones and a hundred small ones were removed from the bladder. The kidneys do not have any stones. See top of page for latest information.
1191. FIC (FUS, FLUTD) in cats. Dr Susan Little's talk on urethral obstruction, FIC in cats
May 10, 2015. The talk at M Hotel, on Sunday, a
Mother's Day was limited to 50 pax and was full house. Dr Susan Little
is a co-owner of 2 cat clinics and an author of cat books, amongst other
veterinary achievements. Here are some of her opinions.
1.2. Use a 3-way stop valve to draw urine and collect it for urine analysis
1.4. She uses warmed saline with sterile lubricant to flush the bladder. Apparently the lubricant is effective in cleaering the mucosa.
1.5
A commercial firm sells the appropriate cat cathether. An orange one
which is softer for indwelling. The one with the stylet (costs more) but
can be used for both purposes - flushing and indwelling. Has a
butterfly for suturing to penile skin.
1.6. Pain relief is important. Suggested opiod and NSAID.
Medocab
for cats (Boelinger?) is great as it is tasteless and given in the
cat's food. She uses it. Her opinion is that tolfedine is old school
and not as good as meloxicam.
1.7 ACP 2.5 mg/cat oral as anti-spasomodic and anti-anxiety is said to be effective.
1.8. Duration of indwelling catheter depends on lab analysis of urine and blood electrolytes.
1.9. Recurring cases. She did not mention perineal urethrostomy in her lecture.
1.10. Damage to pelvic urethra from catherisation rupture case - dye seen pooling in pelvic area on X-ray shown.
1.11. Blood test. Monitor for K+
2. FIC in cats
2.1 Only 5% are due to bacterial infections. 60-70% idiopathic. Therefore she does not prescribe antibiotics.
2.2 Most cases are self-limiting according to her, whether treatment is given or not.
2.3 Litter boxes insufficient. Should be 4 boxes for 3 cats instead of lesser.
2.4 Pain relief is important. Opiod is her favourite.
3. NASAL TUBE FEEDING OF CATS
She said it is easy in her practice with the nurse holding the cat. But give sedation if necessary.
Can email to her if you have queries.
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