962. Scratched by an angry drooling cat
On April 24, 2012, I peeped into the consultation room and saw my assistant Min holding a lasso at a hissing cat about to be treated by Dr Vanessa 1 with subcutaneous fluid and
antibiotics before dental work the next day as the cat had not eaten for the past few days.
"Stop," I said. "You can't lasso the cat in an open consultation room."
Actually I had thought them what to do with aggressive cats which are rather rarely encountered and I presumed they have forgotten.
What happened was that this cat came in with drooling and bad breath and I had demonstrated to Dr Vanessa how I would examine the cat. I put the cat on the examination table, opened his mouth wide and shown the white torch-light inside the mouth.
The cat was rather quiet but he got quite fed up with me as I pried open his mouth again to check for oral tumours and ulcers and plaques in the fauces (back). He had pain in the mouth and here I had not respected him.
The careful thing to do would be to sedate him to examine his mouth but he was sickly and had a fever. I advised treatment with fluid and antibiotics first and dental work under anaesthesia the next day.
So, in the afternoon, there was Min, with bite scars from dogs and cats, holding the lasso inside the consultation room and preparing to get the cat out of the wooden crate.
I went into the room to show how I would restrain the cat by the scruff of the neck. "Take the cat cage into the room," I told Min as we need to put him into a crate. His owner had a small rattan box carrier and no angry cat would go in.
Min said: "My hand is weak, can't do it."
So Min could not restrain the cat for injection by me. He had some bad luck with cats as he had not been able to read "angry cat or dog behaviour" and got some serious hand injuries in the past year and I had to get him to see the human doctor twice!
This was despite the fact that he had worked in a Malaysian vet surgery the year before.
As the consultation room is very small, I asked her to leave the room. I took the cat out of the crate, placed him on the consultation table. No problem so far but the cat's tail and back hairs were up. He started hissing.
From the look of his eyes, I know I had no time. "Open the crate upper door," I shouted to Min. Just in time, I put the cat into the crate. He hissed and jumped up like a pole vaulter. His claws pricked in my left hand and my middle finger of my right hand. Min got some claw marks too.
It was a matter of seconds, like a lightning strike.
"The best way is to sedate the cat inside the crate with Zoletil 100 IM according to weight, and commence with the dental work," I said to Dr Vanessa.
"You must inform the owner of the change of plans," Dr Vanessa reminded me. So, she did the necessary and had the cat's 4 rotten back teeth extracted, did scaling and sent the cat home the next day. Not a single claw scratch for her!
As a routine, I do open the mouth of all salivating cats. Maybe, I ought to do it once and not more times. But no cat would co-operate as he has oral pain and a visual examination is important to plan for treatment.
Fortunately, we don't encounter many dangerous cats at Toa Payoh Vets as Min does the front-line. In this case, if he had lassoed the cat, all hell will break loose. It is important to reinforce instructions to staff several times as different situations occur and staff are people who think in different ways.
Thursday, April 26, 2012
961. An old dog pants heavily. This is a serious health problem for the old dog.
AN OLD DOG PANTS HEAVILY - AN ULTRASOUND TO CHECK FOR LIVER CANCER? E-MAIL TO DR SING DATED APRIL 26, 2012 To: judy@toapayohvets.com Dear Mdm I would like to make an enquiry about my dog (Schnauzer-cross). She is 15 years old. We brought her to the vet as she was panting heavily and her stomach swelled and keeps hiding in the room, away from the rest of the family. X-ray results shows that she has an enlarged liver. Also, the blood test shows that she has high Calcium, high platelets and white blood cells. Most likely, says the vet, my dog has cancer and recommended an ultrasound at its hospital. Meanwhile, the vet has given her some liver medication and my dog's condition has improved though the vet did share that this would be temporary. I am worried about the costs of sending my dog to their hospital as I did some research and found that the hospital tend to order several tests and cost of the treatment usually escalates. If she is found to have cancer, it's likely that we will not opt for treatment as she is old and already her quality of life is poor, with poor eyesight etc. Does your clinic offer ultrasound services and how much does it cost? Is ultrasound the best option for my dog now? My family wants to see her pass on without suffering too much. What should I do to alleviate her suffering? I would really appreciate if you could advise me. Please feel free to call me if need be. Rgds Name & Phone
E-MAIL REPLY FROM DR SING DATED APRIL 26, 2012 I am Dr Sing from Toa Payoh Vets. We spoke by phone today Apr 26, 2012, 3.31 pm and the following is my brief reply to you: In my opinion, the important health care issues in your old dog are: 1. what is the cause of "panting heavily" and "swollen stomach" 2. what is the cause of the "high platelet and white blood cell count" Is there liver cancer or not? Is there a cure? If the cause of the illness is known and treatment can be effective, it should not be "panting heavily".
AN OLD DOG PANTS HEAVILY - AN ULTRASOUND TO CHECK FOR LIVER CANCER? E-MAIL TO DR SING DATED APRIL 26, 2012 To: judy@toapayohvets.com Dear Mdm I would like to make an enquiry about my dog (Schnauzer-cross). She is 15 years old. We brought her to the vet as she was panting heavily and her stomach swelled and keeps hiding in the room, away from the rest of the family. X-ray results shows that she has an enlarged liver. Also, the blood test shows that she has high Calcium, high platelets and white blood cells. Most likely, says the vet, my dog has cancer and recommended an ultrasound at its hospital. Meanwhile, the vet has given her some liver medication and my dog's condition has improved though the vet did share that this would be temporary. I am worried about the costs of sending my dog to their hospital as I did some research and found that the hospital tend to order several tests and cost of the treatment usually escalates. If she is found to have cancer, it's likely that we will not opt for treatment as she is old and already her quality of life is poor, with poor eyesight etc. Does your clinic offer ultrasound services and how much does it cost? Is ultrasound the best option for my dog now? My family wants to see her pass on without suffering too much. What should I do to alleviate her suffering? I would really appreciate if you could advise me. Please feel free to call me if need be. Rgds Name & Phone
E-MAIL REPLY FROM DR SING DATED APRIL 26, 2012 I am Dr Sing from Toa Payoh Vets. We spoke by phone today Apr 26, 2012, 3.31 pm and the following is my brief reply to you: In my opinion, the important health care issues in your old dog are: 1. what is the cause of "panting heavily" and "swollen stomach" 2. what is the cause of the "high platelet and white blood cell count" Is there liver cancer or not? Is there a cure? If the cause of the illness is known and treatment can be effective, it should not be "panting heavily".
Wednesday, April 25, 2012
960. Update: Feline Eosinophilia Granuloma Complex (Images)
For veterinary students studying hard on oral conditions in the cat, the
updated website and more images are
at:
http://www.toapayohvets.com/20120415feline-eosinophilic-mouth-ulcers-young-stray-cat-singapore-ToaPayohVets.htm
Tuesday, April 24, 2012
959. What to do? Carrier cover closed on the cat's tail
April 24, 2012
I saw the consultation table stained by KMnO4 today and was quite furious that there was no newspapers being used to protect this table. Vets who don't bother to take care of equipment will have to pay for the damages. The KMnO4 powder was applied to stop the bleeding from the cat's tail. Somebody had closed the lid on the longer tail of the cat and injured it.
There was hysteria and bleeding. So the vet used KMnO4 and did not bother to use the newspaper to protect the table. "KMnO4 does not work in stopping bleeding of bigger tail wound," I said.
"In such situations, treat it as an emergency and apply the following procedures:"
1. Be firm and ask the owner to wait outside the at the waiting room.
2. Bring the cat to the surgery room.
3. Sedate if necessary as the cat gets excited and worried with all the human commotion.
4. Pressure bandage will stop the bleeding.
Bandaging and cleaning the wound would be better.
PREVENTION Get the owner to put the cat in her carrier when she comes to take her cat back. I had given such instructions for owners to cage their own cats and not let the assistants do it. All of us learn from experiences.
There was hysteria and bleeding. So the vet used KMnO4 and did not bother to use the newspaper to protect the table. "KMnO4 does not work in stopping bleeding of bigger tail wound," I said.
"In such situations, treat it as an emergency and apply the following procedures:"
1. Be firm and ask the owner to wait outside the at the waiting room.
2. Bring the cat to the surgery room.
3. Sedate if necessary as the cat gets excited and worried with all the human commotion.
4. Pressure bandage will stop the bleeding.
Bandaging and cleaning the wound would be better.
PREVENTION Get the owner to put the cat in her carrier when she comes to take her cat back. I had given such instructions for owners to cage their own cats and not let the assistants do it. All of us learn from experiences.
958. Uterine prolapse in the cat - seen by Dr Sing
On Tue, Apr 24, 2012 at 3:33 AM, Sorrel J Langley-Hobbs wrote:
Dear Dr Sing Kong Yuen, I am writing a chapter on the feline genital tract and would like an image of a uterine prolapse to include in the chapter. I found yours - the website was forwarded to me by another veterinarian. If you have a higher resolution image of the uterine prolapse (attached) - needs to be 300dpi and about 10cm x 10cm then it could be publishable. I would of course acknowledge you for use of the picture. thanks very much Sorrel Langley-Hobbs -- Sorrel Langley-Hobbs MA BVetMed DSAS(O) DECVS MRCVS European Specialist in Small Animal Surgery University Surgeon Head of Small Animal Surgery, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 OES Tel 01223 337621 / 337653 Fax +44 1223 330848 Email - SJL41@cam.ac.uk
E-MAIL REPLY FROM DR SING DATED APRIL 24, 2012
Hi I am Dr Sing. The picture was taken many years ago and at that time, the images were on poor quality as I was just starting out my digital photography. Pl feel free to use the image and I have not seen any more such cases of uterine prolapse in the cat. Best wishes
Dear Dr Sing Kong Yuen, I am writing a chapter on the feline genital tract and would like an image of a uterine prolapse to include in the chapter. I found yours - the website was forwarded to me by another veterinarian. If you have a higher resolution image of the uterine prolapse (attached) - needs to be 300dpi and about 10cm x 10cm then it could be publishable. I would of course acknowledge you for use of the picture. thanks very much Sorrel Langley-Hobbs -- Sorrel Langley-Hobbs MA BVetMed DSAS(O) DECVS MRCVS European Specialist in Small Animal Surgery University Surgeon Head of Small Animal Surgery, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 OES Tel 01223 337621 / 337653 Fax +44 1223 330848 Email - SJL41@cam.ac.uk
E-MAIL REPLY FROM DR SING DATED APRIL 24, 2012
Hi I am Dr Sing. The picture was taken many years ago and at that time, the images were on poor quality as I was just starting out my digital photography. Pl feel free to use the image and I have not seen any more such cases of uterine prolapse in the cat. Best wishes
957. Eosinophils and monocytes compared in two old dogs
April 24, 2012
Blood test done by the same lab on two aged dogs.
An interesting case of the circling dog to be compared to an ordinary case of maggot wounds.
Case 1. The circling Schnauzer 12 years old, Male - Dr Sing's case
Date of test April 23, 2012
Total WCC 6.2 (6-17)
Neutrophils 71.5% 4.43 (absolute)
Lymphocytes 11.3% 0.70
Monocytes 6.5% 0.40
Eosinophils 9.6% 0.59 Basophils 1. 0% 0.06
PCV 0.47 (0.37 - 0.55)
Platelet 337 (200-500) Few giant platelets seen. No platelet clumping noted.
Glucose - specimen grossly haemolysed. Query glycolysis. Suggest repeat.
April 24, 2012. Day 2 after treatment. 10am. Dog does not cry. Sedated. Can walk with head straight but ataxic. No circling. Went home on April 25, 2012 with no head tilt. To review.
Case 2. The eye-maggot-wound Golden Retriever 14 years old, Male - Dr Vanessa's case Numerous maggots below R eyelid
Date of test April 20, 2012
Total WCC 22.5 (6-17)
Neutrophils 90.8% 20.43 (absolute)
Lymphocytes 7.6% 1.71
Monocytes 0.3% 0.07
Eosinophils 1.2% 0.27 Basophils 0% 0.0
PCV 0.39 (0.37 - 0.55)
Platelet 276 (200-500) Large platelets present. Platelet clumping noted.
Glucose 3.9 (3.9 - 6)
Conclusion: The monocytes and eosinophils were very high in Case 1. Case 2 would be considered to have normal ones but the total white cell count and neutrophils were high (bacterial infection) .
Could Case 1 be suffering from a chronic illness? For example, bad rotten teeth infection - toxins and bacteria travelled via the Eustachian tube to the middle ear and the brain? This resulted in increase in monocytes and eosinophils and a possible auto-immune reaction?). Hard to confirm unless a spinal tap is also done. There is the economics additional tests to be considered.
Case 1. The circling Schnauzer 12 years old, Male - Dr Sing's case
Date of test April 23, 2012
Total WCC 6.2 (6-17)
Neutrophils 71.5% 4.43 (absolute)
Lymphocytes 11.3% 0.70
Monocytes 6.5% 0.40
Eosinophils 9.6% 0.59 Basophils 1. 0% 0.06
PCV 0.47 (0.37 - 0.55)
Platelet 337 (200-500) Few giant platelets seen. No platelet clumping noted.
Glucose - specimen grossly haemolysed. Query glycolysis. Suggest repeat.
April 24, 2012. Day 2 after treatment. 10am. Dog does not cry. Sedated. Can walk with head straight but ataxic. No circling. Went home on April 25, 2012 with no head tilt. To review.
Case 2. The eye-maggot-wound Golden Retriever 14 years old, Male - Dr Vanessa's case Numerous maggots below R eyelid
Date of test April 20, 2012
Total WCC 22.5 (6-17)
Neutrophils 90.8% 20.43 (absolute)
Lymphocytes 7.6% 1.71
Monocytes 0.3% 0.07
Eosinophils 1.2% 0.27 Basophils 0% 0.0
PCV 0.39 (0.37 - 0.55)
Platelet 276 (200-500) Large platelets present. Platelet clumping noted.
Glucose 3.9 (3.9 - 6)
Conclusion: The monocytes and eosinophils were very high in Case 1. Case 2 would be considered to have normal ones but the total white cell count and neutrophils were high (bacterial infection) .
Could Case 1 be suffering from a chronic illness? For example, bad rotten teeth infection - toxins and bacteria travelled via the Eustachian tube to the middle ear and the brain? This resulted in increase in monocytes and eosinophils and a possible auto-immune reaction?). Hard to confirm unless a spinal tap is also done. There is the economics additional tests to be considered.
956. Miniature Schnauzer with head turned left
Yesterday, April 23, 2012, I was surprised to see a 12-year-old Miniature Schnauzer I had not seen since 11 years ago. A young couple in their mid 20s came with the dog whose head tilted or turned left at around 90 degrees to the neck.
I recognised the name of this dog which was one of a kind and recalled the father who brought this dog specially for the young daughter who was 12 years old then.
As he lived quite far from Toa Payoh, it was understandable that I had not seen this dog. There could be other reasons but this is expected. "Was the dog walking in circles?" I asked. "Yes," the young lady said. "At first wide circles near the wall. Now, in small circles. Always circling to the right."
Sudden onset 2 weeks ago said to have fallen from the couch. Vet 1 examined and said nothing was abnormal. Soon the dog started walking in smaller circles and crying. The daughter decided to consult me. The father wanted euthanasia as the dog was whining the whole day and restless.
Yet he ate and had not lost much weight. He vomited the food recently. What's the cause of this circling? Is there a solution?
There was mild pain in the spinal area on palpation esp. T/L and inside the ears when I applied a cotton bud. Other than that, no cervical pain.
Blood tests were not taken by Vet 1 and no medication or injection was given as the dog was "normal." This was a puzzling case. Middle ear infection or trauma? Ears were quite clean. Infection from bad teeth's bacteria into the brain via the Eustachian tubes to the brain?
The dog had two dentals, the recent one being in January 2012.
TREATMENT Diazepam 1.5 ml sedated the dog for around 2 hours. The dog started to paddle. I gave Domitor+Ketamine at 20% to let him sleep. His neck was now straight due to diazepam. Will wait till blood test results come in today and see what's the problem.
No spinal fluid test is done yet. There's a big below gum upper molar tooth embedded.
Could this tooth be rotten inside the gum, causing bacteria to go up the maxillary sinuses into the frontal sinus and to the brain? Now, there is no bad breath. Ear canal had little yellow wax and grooming was done 2 weeks before the appearance of clinical signs. It is a difficult situation as the cause is still hard to find without X-rays and scans which would cost money.
UPDATE
Blood test - significant results were the high eosinophils and monocytes.
The dog was warded two nights and went home. The head had not tilted 90 degree to the left. When I called him, he could turn his head to the right. So far, he could walk straight and his head pointed normally forward. What is the cause of his circling? He circled from larger circle to small tight circles to the right. He could circle no more in the sense that the circle had become too small. A very rare case reminding me of "scrapie" in the sheep shown by the professors when I studied at Glasgow Vet College some 40 years ago. The sheep was walking in circles and it was quite unforgettable even now.
As he lived quite far from Toa Payoh, it was understandable that I had not seen this dog. There could be other reasons but this is expected. "Was the dog walking in circles?" I asked. "Yes," the young lady said. "At first wide circles near the wall. Now, in small circles. Always circling to the right."
Sudden onset 2 weeks ago said to have fallen from the couch. Vet 1 examined and said nothing was abnormal. Soon the dog started walking in smaller circles and crying. The daughter decided to consult me. The father wanted euthanasia as the dog was whining the whole day and restless.
Yet he ate and had not lost much weight. He vomited the food recently. What's the cause of this circling? Is there a solution?
There was mild pain in the spinal area on palpation esp. T/L and inside the ears when I applied a cotton bud. Other than that, no cervical pain.
Blood tests were not taken by Vet 1 and no medication or injection was given as the dog was "normal." This was a puzzling case. Middle ear infection or trauma? Ears were quite clean. Infection from bad teeth's bacteria into the brain via the Eustachian tubes to the brain?
The dog had two dentals, the recent one being in January 2012.
TREATMENT Diazepam 1.5 ml sedated the dog for around 2 hours. The dog started to paddle. I gave Domitor+Ketamine at 20% to let him sleep. His neck was now straight due to diazepam. Will wait till blood test results come in today and see what's the problem.
No spinal fluid test is done yet. There's a big below gum upper molar tooth embedded.
Could this tooth be rotten inside the gum, causing bacteria to go up the maxillary sinuses into the frontal sinus and to the brain? Now, there is no bad breath. Ear canal had little yellow wax and grooming was done 2 weeks before the appearance of clinical signs. It is a difficult situation as the cause is still hard to find without X-rays and scans which would cost money.
UPDATE
Blood test - significant results were the high eosinophils and monocytes.
The dog was warded two nights and went home. The head had not tilted 90 degree to the left. When I called him, he could turn his head to the right. So far, he could walk straight and his head pointed normally forward. What is the cause of his circling? He circled from larger circle to small tight circles to the right. He could circle no more in the sense that the circle had become too small. A very rare case reminding me of "scrapie" in the sheep shown by the professors when I studied at Glasgow Vet College some 40 years ago. The sheep was walking in circles and it was quite unforgettable even now.
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