153. Fractured nail in Silkie (2nd case)

"It is uncommon for a dog that is groomed regularly to have fractured toe nails," I said. "Yours is the 2nd Silkie with the same problem in this week. I don't get such cases during the whole year and now there are two." "Why didn't the groomer clip the nails short so that my dog will not have his nail caught inside the office carpet? He was suffering great pain and was bleeding." The husband took time off to phone me (apparently referred by his groomer who lives nearby his condo) to get his baby treated urgently. As he wanted to be present, I did not object. He was bigger and more handsome than myself and my assistant and we squeezed inside the small operating room. Normally I disallow owners to view as they distract and disrupt. Sedation: Domitor 0.2 IV. Waited 2 minutes and then my assistant put the dog on the gas mask to give the isoflurane gas. "Take away the mask," I said when I saw the dog gurgling. He was about to vomit. Dogs seldom vomit when given Domitor IV but some do. "I have to change groomer," the husband was upset. "You can see that the groomer did clip all the nails properly," I showed the husband the other nails including the dew claws. There is no need to change groomers. You can trim the nails yourself in between the grooming session or teach the groomer how to do it." As I type this record at 6.35 pm, Friday, Aug 6, 2010, I have this hypothesis: The deviated D3 and D4 claws had grown longer as they were not in contact with the ground and probably grew longer since there was no wear and tear. I did not ask when was the last grooming as I did not have time to consolidate my hypothesis. I did not have time to explain this possibility as the husband appeared to be in a hurry. "Family comes first," he said to his wife. "The dog is the de-stressor in the office and so he is more like a child," the wife explained. When a child is in pain, emergency attention is required. Dog vomited his food 5 minutes later. 

"The dog should be on empty stomach but this is an emergency and he vomited his yellow food and water," I explained. Having a husband inside the operation room took up some time. "Do you advise cutting off the deviated D4 claw? After all, the dog already has fractured stump of D3. What is your advice?" "Just trim it for the time being," I showed how it is done. Imagine a line across the lower level of the pad when placed on the ground. Any claw longer and below this horizontal line (90 degrees to the pad) should be trimmed without pain or bleeding from the quick." I demonstrated by cutting. There was no blood. 

I illustrate for readers' benefit (see picture at www.toapayohvets.com, goto DOGS). If the two deviated claws persist to deviate some 6 months later, I will remove them if you have thought over the matter. For the husband, nails are useless and if they cause problems, may as well remove both of them. That means no more overgrown nails and no more fractured nails. I advised waiting although I could have had done it on the spot as the dog was under anaesthesia and the owner was willing. 

Dog: Teeth scaling and follow-up on an abscessed carnaissal tooth chihuahua

CASE 1. PREVENTING TARTAR BUILD UP IN THE DOG'S TEETH
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 06 August, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129

A mother with four children - 12 years, 15 years, 19 years and 23 years brought 2 Malteses that are 2 years old for their annual vaccination. She made an appointment for dental scaling. Dental scaling was done under anaesthesia. Lots of brown tartar in the canine and back teeth, but the teeth are still solid and strong.

Questions asked by the mum:

1. Yearly dental scaling? Not necessary if there is no tartar. Just ask the vet to check the teeth.

2. Must brush teeth daily? Yes, if practical. If not, every 3 days.

3. Dog does not like brushing. What to do? Use thumb brush or rag to rub back teeth. Use treats to motivate.

4. How to prevent tartar build up on the teeth? Presently the dogs eat chicken meat mainly. "Add dry dog food for the dog to chew," I said. "There are also chew ropes, but one way is to feed dry dog food and brushing of the teeth."

"My dogs will never eat dry food," the mother said.

"Even you will never eat biscuits if forced to," I said to the caring mother. "The trick is to add 5% to chicken meat, gradually increasing to 50% after one month. Delay dinner as the dog eats once a day."
As I had time, we talked about our experiences in bringing up children and she had four of them. "My 15-year-old is the naughtiest and always wants to go out."

"That's due to her hormones", I said. "She wants to meet boys. You need to spend some time with her, for example. exercising the two dogs together with her. Bonding with her, getting to know her better." I had thought that the 12-year-old daughter would be harder to manage as she should be having hormonal changes to become a woman. Yet it was the 15-year-old. I don't know much about daughters as I don't have any.

The mum said she used to take half-hourly walks when first diagnosed with Diabetes Type II. Now, she gave up exercising. "You need company," I said. "It is just too boring to walk by yourself and spouses are usually not available or interested.

"You have two dogs. Just take one dog down at a time since two dogs are noisy. If you don't take care, you may get diabetes Type I and then you will need to inject yourself everyday ", I advised the mum. She has to take care of herself as she has 4 children and 2 dogs and that is a heavy responsibility.
CASE 2. FOLLOW-UP 7 MONTHS AFTER I EXTRACTED THE ABSCESSED CARNAISSAL TOOTH
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
06 August, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129

What to do if you, as a vet do not feel comfortable in performing anaesthesia in old dogs which may only be cured if surgery is done?

I know of one vet who just simply refers all cases to another practice. "At least I don't lose clientele when I refer to this practice," the vet told me. This practice has several vets and if this vet believes that referring her difficult cases to this practice will not cause her loss of clientele, I find it hard to believe. I reserved comments. A practice with more vets has higher overheads and therefore needs the caseload to sustain the profitability of the big operation. Recently I asked my mentor about this vet's comments. My mentor who is in his late 60s said: "Once you refer a case, you lose your client."

Referring to other practices means losing clientele. There is no way to stem such losses if the vet does not want to perform risky surgeries that will harm his or her professional reputation.

Deaths on the operating table are very emotional and unpleasant issues. In this Chihuahua with an abscessed carnaissal tooth, the vet just advised conservative treatment for 12 months. This vet would not perform surgery knowing that it would be very risky. Anaesthesia in old dogs is going into areas where angels fear to thread as it is high risk. Yet, some surgeries cure the dog promptly. There is always a big dilemma for vets encountering such situations.

It was a joy to see this Chihuahua some 7 months after I extracted her abscessed carnaissal tooth and many other teeth. I tried my hand at making a short video with the help of an intern at: Abscessed Carnaissal Tooth Diagnosis and Treatment Video Education For Vet Students. Three follow-up pictures of the pretty Chihuahua are taken for viewers:


7 months ago
Dirty, wet itchy left facial area below the eye. The mum had to clean the non-healing wound for the previous 12 months. It was a daily chore for the old mother for 12 solid months.

7 months later
No pain and good looking and a happy mum. The grown up son had to seek a vet who would operate on the dog but he knew it was a high risk anaesthesia. It is not always a happy ending. Yearly dental check up by your vet will prevent so much dramas and worries for the family members who are care-givers to the dog.



More info at: Dogs or Cats
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129


Pictures are at www.toapayohvets.com.

151. How to help search engines find your website

Pcworld.com Mar 2010

1. Determine priorities
Develop measurable goals and priorities
What you want visitors to do, buy or learn (products and services more important to promote). Google Analytics reveals which keywords visitors used and more.

2. Research keywords. Free Google AdWords Keyword Tool useful. How often keywords ae searched. Other paid tools offer Keyword Effectiveness Index (KEI)

3. Use keywords judiciously.
3.1 One page on a single subject
3.2 Use keywords in the page's HTML itle tage <65 characters incl spaces and punctuation
3.3 Add keywords in HTML h1 and h2 headings and in the body copy several times
3.4 Create a keyword-rich link elsewhere to each optimised page.
3.5 Add keywords to your site's URLs

4. Create "Linkbait"
from soomeone else endorsing your product or service. Useful if they include a keyword-rich link o your company's relevant page

Ensure your pages have exgtremely useful content (link-bai). Spread the word about a new blog post, page or article via social networks (search engines love blogs.

5. Make website search engine friendly. Bots primarily index text and follows links.
5.1 use a textg browser eg. Lynx to see how mosgt search engine bots see your site. Paste a URL into the Lynx viewer to find out how the page looked.
5.2 No duplicate content or multiple URLs pointing to the same page.
5.3 Creae an XML sitemap. Submit it to search engines.

Keep Going. Review.

150. Cat scratched the vet

White cat. 13-year-old. Not eating for past 2 days. Owner was free at 7 pm, so I waited for him.

"Open your mouth," the man in his 50s shouted at the cat. "Some bad breath". Surprisingly this cat growled and hissed but did not scratch him.

I open her mouth to examine for ulcers. No tongue ulcers. Gingivitis. In an instant the cat sunk her claws into my left middle finger. 2 deep wounds. My assistant got me the swab and tissue. I washed the wound well as some people do get cat scratch fever.

The claw outer sheath fell on the consultation table as the cat withdrew her claw. This was a cat that had given warnings but I had to open her mouth to check why she was not eating.

Dehydrated as neck skin stood up 30%. Gave IV drip. Will do dental tomorrow.

149. Rabbit with matted anal hairs and stools, eye discharge

5-year old dwarf rabbit

"Rabbit bites," the young lady warned me. She wanted the rabbit in a one-stop shop with vet and rabbit groomer.

My assistant held the rabbit's head in between the towel while the rabbit groomer clipped the hairs carefully. My intern Ms Lai held on to one leg to assist the groomer. The rabbit seemed quiet. Eye discharge removed. Paw hairs trimmed. "Trim the belly and scrotal area," I asked the groomer. Matted hair and big stool in hair clipped off.

Warm water in bath tub. Rabbit bathed. "The owner said that the noise of the hair dryer upsets the rabbit." So the groomer blew dry from far away. The rabbit did not panic.

Only the lower left incisor was normal size and overgrown. The other three were around 2 mm long. Why?

"Vet 1 clipped the two top teeth some months ago. The two teeth just fell off. This rabbit had no teeth problems in the past years."

Rabbit looked good. If the rabbit does not bite the family members, the rabbit can be groomed at home. Eye cleaning is important. Easily said than done.

148. Weighing hamsters

"It is important to weigh hospitalised hamsters daily," I explained to Ms Lai. The dwarf hamster with cellulitis had lost 4 grams since admission with a foul stench. A rotting flesh smell permeated the consultation room. On Day 1, 48g bodyweight , it was bathed.


Still has bad body smell. Now 44g. Lost 4g. Bathed on Day 3 (I took pictures of bathing hamster. He seemed traumatised but had to bathe him as he was very dirty and infected).

1.We bathed the hamster in warm water as he was still active. No cold water. A lot of dirty white flakes and hairs washed away.
2. Dried with tissue gently on ventral aspect. Do not be too heavy-handed as lower body skin is infected badly
3. Baytril and pred oral. Electrolytes.
4. Need to hand-feed.
5. Hamster ate the next day.

Day 4. Felt better. Given electrolytes every hour or so. Ate. Passed stools.
Day 5. More active. Liked to eat golden yellow flakes. Passed stools. Skin on shoulder not so red. Picture taken. Loose yellowish brown stools observed on photograph. Stop electrolytes. Now 41 g.
Got to hand feed him ground pellets every hour or so but he is eating too.

147. Advices on dental tartar

A mother with four children - 12 years, 15 years, 19 years and 23 years. 2 Malteses at 2 years old.

Vaccination. Done.
Dental scaling. Lots of brown tartar but teeth are still solid and strong.

Questions asked:
1. Yearly dental scaling? Not necessary if no tartar. Just check up.
2. Must brush teeth daily? Yes, if practical. If not, every 3 days.
3. Dog does not like brushing. What to do? Use thumb brush or rag to rub back teeth. Use treats to motivate.
4. How to prevent tartar? Presently the dogs eat chicken meat mainly. "Add dry dog food for the dog to chew," I said.
"My dogs will never eat dry food," the mother said.
"Even you will never eat biscuits if forced to," I said to the caring mother. Her 15-year-old is the naughtiest and always wants to go out." That's due to her hormones, I said. "She wants to meet boys. You need to spend some time with her, e.g. exercising the two dogs, bonding with her, getting to know her and reducing your weight too. Just take one dog down at a time since two dogs are noisy."
I said: "The trick is to add 5% to chicken meat, gradually increasing to 50% after one month. Delay dinner as the dog eats once a day."