1170. A British Shorthair vomits for the past 10 months and become thinner. Why?

Nov 15, 2013

British Shorthair, F,S, 5 years old. Spayed.
A gentle cat with bright yellow eyes.
Just get thinner and thinner. Vomits grey + brown stuff (would be grey hairballs and dry food) occasionally. The rectal temp dropped below 38C yesterday.

"It is not possible to come to a diagnosis without blood tests, urine tests and  X-rays," I said. Vomiting for many months can be weaken the cat and cause death. So, there is a need to do the lab tests. A lot of time spent talking to the young couple. The cat does lick toilet floor water over the years and this may harm her kidneys.

Blood test - urea below normal. Creatinine is normal though.

Advice:
Hygiene. Keep toilet floor dry. Quarantine cat to clean area


  

1169. Vomiting & diarrhoea - kidney stones in a dog

TOA PAYOH VETS toapayohvets.com Date:   15 November, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits The Silkie had double kidney stones Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   15 November, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Silkie Terrier, F, spayed, 13 yearsFed dry food + bread since 5 years of age (adopted from another owner who migrated). 2 days ago, presented with vomiting and diarrhoea. I treated and advised blood tests and X-rays if the symptoms persisted. The dog came back yesterday, "dying" according to Dr Daniel who got the X-rays and blood tests done. A rare case of kidney stones in the 2 kidneys was diagnosed based on evidence. Dogs usually suffer from bladder stones. No urine tests done in this case.  Blood urea and creatinine are extremely high. The dog vomits dark brown fluid in the crate and has heavy abdominal breathing as at 11.14 am Nov 13, 2013 when the lady owner came to visit as I phoned her to say that the dog was suffering in pain and was on the last leg of his life. The dog vomited white froth on the reception room floor. The owner will bring home for today and had decided on euthanasia later in the day.   Two kidneys are packed with stones Vomiting and diarrhoea can be a sign of kidney failure although most cases are due to gastroenteritis. This dog was treated for gastroenteritis at the first consultation without blood test so as to reduce medical costs. As the vomiting persisted, I advised a blood test and Dr Daniel took it since I was out. This was a case of renal urolithiasis resulting in kidney failure.    Updates will be on this webpage: http://www.bekindtopets.com/dogs/20131114two_kidneys_ with_stones_Silkie_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: November 15, 2013 Toa Payoh Vets

1168. A dog, a cat and a guinea pig on Thursday evening Nov 14, 2013

Thursday, Nov 14, 2013

Closing at 8 pm is too early as most urban clients work past 6 pm and have no time to see the vet who closes at 8 pm.  Closing at 10 pm would be too long a day as I start at 9 am and a vet can burn out working long hours 7 days a week. This Thursday evening, Dr Daniel went to the gym with his mum  at 6.15 pm and so I took over and expected a quiet evening.



Case 1. The Guinea Pig
The first case to come in was a young 6-month old grey golden-haired streaked guinea pig with thick wax and scales on the left ear canals and scales on the right ear, plus a circular patch of hair loss further behind.. "The pet shop operator who sold me the my guinea pig has fungal infections," the young lady said. My assistant Naing checked the computer and brought out an incorrect case card after browsing the data of salesforce.com. The Yishun address was incorrect as regards the unit number. It was #4-48, the 4th floor and the pet was a stray cat.
"Search for unit '11-48'  and he got the correct case card. I had no time to check why salesforce.com did not provide this unit as I find it to be quite versatile. I asked permission for isoflurane + oxygen gas anaesthesia of the guinea pig, got the ear hairs clipped, ears cleaned up and irrigated. I injected the anti-mite and prescribed the anti-fungal wash as microscopic examination of the left ear hairs showed ringworm.  The guinea pig went home with reviews 2 weeks later but most owners don't return if the guinea pig is OK.

Case 2. The Golden Retriever Dog
"Vomiting and diarrhoea" for the past few days, the man in his late 40s had paid $3,000 for this Australian-imported 6-month-old that was never let out of the house and fed only dry dog food. The dog was thin too although he ate ravenously. "You may be under-feeding," I palpated the abdomen "Can you hear the sounds of gas? Place your ear closer to the dog's abdomen."
I palpated the abdomen.  Loud gushy gurgling sounds were heard distinctly.
"You see, this dog's intestines are bloated with lots of gas! I need a blood test and stool test and stabilise the dog with IV drip and medication first."
The owner was surprised to hear the loud sound. The dog was hospitalised for observation.

Case 3. The British Shorthair
The young couple in their early 30s brought a thin grey spayed 5-year-old cat for examination. "Keeps vomiting for the past weeks but not every day. The cat ate but lost weight and peed a lot. She behaved active. We saw another vet who prescribed probiotics some weeks ago."
I checked the gums. The gums were pale but capillary refill time was normal at <2 a="" abdomen="" and="" are="" barely="" bladder="" blood="" br="" cat="" check="" clot="" could="" down="" feel="" feels="" full="" had="" half="" he="" i="" is="" kidney.="" kidneys="" left="" lips="" nbsp="" normal.="" not="" on="" palpated="" seconds.="" shrunk="" the="" thickened.="" to="" turned="" upside="" vulva.="" vulval="" wall="" which="">
"Can you collect a urine sample?" I asked whether the cat peed a lot of times per day.
"We work and so don't know whether he pees a lot. It is not possible to collect as the cat goes to the litter
 to pee and the litter absorbs the urine. Can you collect it?
"I suspect kidney disease or diabetes with urinary tract infection and so need a blood test and X-ray if I can't get the urine. Otherwise, it is hard to diagnose what's wrong."
"Is it possible that the cat has inherited some genetic kidney disease?" the young man asked. Nowadays, the young generation does a lot of research and knows a lot of medical knowledge.
They will bring in the cat tomorrow morning for the blood test which can only be taken under anaesthesia as the cat was quite fed up with my palpations. He hissed a bit now and then to warn me.


It was a strange evening for me in the sense that I got 3 different animals. The guinea pig was an old client with a rabbit earlier for treatment. The other two were new clients. Performance counts and I need to give the correct diagnosis using evidence-based medicine.

Was the cat having kidney disease or diabetes with UTI? Was the dog having parvoviral infection or just allergy to existing dog food since he was thin and was brought recently. Usually Golden Retrievers are sold by 3-4 months of age, not at 6 months. Would the guinea pig recover fast? I think so.

1168. Myanmar Vet Conference Feb 2, 2014 - Dwarf hamster anaesthesia & surgery - Case study

PRESENTATION OF CASES AT MYAANMAR VET CONFERENCE 2014

Case Study 1. TP 44770
Nov 2, 2013. Neepy, Roborovski, Male, Not Neutered, 2 years, Bodyweight 44 g
Difficulty in walking as the left hind thigh has a large soft mobile subcutaneous tumour. The right chest had a similar tumour which developed earlier. Both tumours were present for a couple of months. The chest tumour was small and "disappeared" but re-appeared again. 

SURGERY ON NOV 3, 2013
Anaesthesia & Surgery
Bodyweight 44 g. Active & eating.
A: 1.24 pm Zoletil 50 2 drops IM

B:                Isoflurane + O2 not given
C:                Isoflurane + O2 not stopped
D: 1.26 pm First skin incision (Dr Daniel, scalpel blade)
E:  1.33 pm Completeion of skin stitching
E-D = 7 minutes


Duration of analgesia sufficient to excise 2 tumours using scalpel (Dr Daniel Sing) = 7 minutes.
No need isoflurane gas top up.
4/0 monosyn sttiches.
As the hamster is old, I had advised removal of the 2 tumours in 2 stages to prevent deaths on the operating table.

3894 - 3897. Two large tumours below the roborovski's chest & abdomen

Histopathology of one tumour 1.5 cm x 1.0 cm x 0.5 cm
A fairly well circumscribed nodular pr oliferation of spindled cells set within a fibrocollagenous stroma. The spindle cell population is relatively monomorphic and contains ovoid nuclei and some lightly eosinophilic cytoplasm. They are arranged in a vague storiform manner and also in short fassccles. No significant nuclear atpia, increased mitotic activity or necrosis is seen. There is no evidence of malignancy.
Diagnosis: Benign spindle cell neoplasm.
Comment: Differential diagnoses include a benign fibrous histiocytoma or fibroma, amongst others. Definitive subtyping of the tumour would require an immunohistochemical work-up. Report was given to the owner.



FOLLOW UP ON NOV 14, 2013
I phoned the owner.  The hamster is OK and had bitten off the stitches. No open wounds.

The hamster had one week oral baytril and meloxicam 0.02 ml/day and had no side effects of loss of appetite or enteritis. He was normal and could walk properly. He was banned from the exercise wheel for one week.
   

1164. ANAESTHESIA IN THE DWARF HAMSTER - Zoletil & Gas Mask

 

THE SURGICAL PATIENT

 

 

 

ZOLETIL

 

Zoletil^(R) is a combination of a dissociative anesthetic agent, tiletamine hypochloride, and a tranquilizer, zolazepam hypochloride.

 

 

 

Zoletil^(R) is a combination of a dissociative anesthetic agent, tiletamine hypochloride, and a tranquilizer, zolazepam hypochloride.

Zoletil^(R) has now been available for more than 10 years in Europe, Latin America, Asia, and in the Pacific area.

Zoletil^(R) is very comfortable to use thanks to:

A HIGH THERAPEUTIC INDEX
In dogs:

• Average dosage: 5-7 mg/kg
• Lethal dosage: 100 mg/kg

In cats:

• Average dosage: 7-10 mg/kg
• Lethal dosage: 220 mg/kg

LIMITED SIDE EFFECTS

• No cardiorespiratory depression
• No epileptic effect
• Transient decrease of body temperature
• No hepatic or renal toxicity
• Laryngeal, palpebral, and pharyngeal reflexes are maintained
• Can be used on pregnant bitches and queens

EFFECTIVENESS

• Fast onset of action: within 1 minute by IV route, 3-5 minutes by IM route
• Good anesthetic effect
• Instantaneous muscle relaxation
• Immediate superficial analgesia
• Smooth awakening: between 30 minutes to 2 hours

MULTI PURPOSE
Zoletil^(R) is a very convenient injectable anesthetic agent:
The following indicative guidelines will illustrate how Zoletil^(R) can be used in a variety of procedures in cats and dogs, ranging from restraint to orthopedic surgery.

General advice

Food
It is advisable to withhold food for 12 hours before injection of Zoletil^(R).

Body temperature
Body temperature should be monitored Animals should be protected from body heat loss.

Eyes
The eyes normally remain open with the pupils dilated. The use of an ophthalmic ointment is advisable to protect the cornea from desiccation.

Dosage
Do not exceed the maximum safe dose of 72 mg/kg of bodyweight in cats.

Recovery
Recovery time depends on doses, injection route, general status of the patient.
Smooth recovery in cats.
For an optimum recovery, the patient should be kept away from loud noises and bright lights.

Storage
Non-reconstituted product should be used within 2 years. Once reconstituted, Zoletil^(R) can be kept 8 days at 4°C (over 90% efficacy maintained).

Warning
Factors affecting response to immobilizing medicines include:

• age, sex, reproduction status
• general nutritional status (obesity)
• concomitant diseases

Doses are given according to the species and the type of procedure used.

Doses are flexible taking into account the status of the subject.

Doses should be reduced in geriatric and debilitated patients.

Sedation

Zoletil^(R) is indicated for minor procedures such as immobilization and handling, diagnostic examination and restraint:

• Allows a good quality sedation
• Onset of action is quick:3-5 minutes

RECOMMENDED PROTOCOL

• Zoletil^(R) 5 mg/kg

Biopsies/wound cleaning
Zoletil^(R) is very convenient to use for minor surgeries such as biopsies, wound cleaning, suturing:

• Short duration anesthesia is possible
• Easy to administer by IM route
• Highly safe for the patient
• Does not lower blood pressure

RECOMMENDED PROTOCOL

• Premedication: 15 minutes before induction glycopyrrolate (0.01 mg/kg IM or SC) or atropine (0.05 mg/kg SC)
• Induction: Zoletil^(R) 5-7 mg/kg IM

Dental procedures

Sedation may not always be enough to operate and a short duration anesthesia is then required.

Zoletil^(R) allows comfort of use:

• Preserves the laryngeal reflex so there is no need for intubation
• Easy to use
• Allows muscle relaxation, needed because procedures often need a mouth large open

RECOMMENDED PROTOCOL

For orthodontics/short procedures (20 minutes)

• Premedication: 15 minutes before induction atropine (0.05 mg/kg SC) to reduce salivation
• Induction: : Zoletil^(R) 10 mg/kg IM

For dental care/long procedures (40 minutes)

• Premedication: 15 minutes before induction atropine (0.05 mg/kg SC) to reduce salivation
• Induction: Zoletil^(R) 15 mg/kg IM

Urinary surgery

The health status of the patient is usually critical when brought for an urinary surgery. The use of a very safe anesthetic agent is therefore required.

Zoletil^(R) is an anesthetic agent of choice for urology procedures:

• Highly safe for this type of patient:
  Tiletamine has no direct effect on kidney functions, so it avoids bradycardia and hypovolemia
• Allows muscle relaxation and sedation
• A maintenance protocol is possible
  Zoletil^(R) has no cumulative toxicity so it can be re-injected

RECOMMENDED PROTOCOL

• Renal checkup
• Premedication:15 minutes before induction atropine (0.05 mg/kg SC)
• Induction: Zoletil^(R) 5 mg/kg IM
• Maintenance: Inhalation anesthesia or Zoletil^(R) (2-3 mg/kg IM) if needed
• Fluid therapy necessary during anesthesia and post surgery

Male cat neutering

Zoletil^(R) is very convenient to use in this type of routine surgery:

• Short duration anesthesia is possible
• Easy to administer by IM route
• Highly safe for the patient

RECOMMENDED PROTOCOL

• Premedication: 15 minutes before induction glycopyrrolate (0.01 mg/kg IM or SC) or atropine (0.05 mg/kg SC)
• Induction: Zoletil^(R) 7 mg/kg IM

Caesarian sections

As anesthetics pass trough the placental barrier and can have an impact on kittens, an optimal anesthesia should be:

• a short duration one
• with a short lap between induction and delivery
• with a flexible dose regime
• cause only a mild respiratory depression in kittens

Zoletil^(R) is an anesthetic agent of choice for these procedures:

• Highly safe for the mother and kittens:
  Zolazepam has no depressant effect on the respiratory system,
  Tiletamine does not lower arterial pressure
• Allows a quick awakening of the mother without hypothermia

RECOMMENDED PROTOCOL

• Premedication: 30 minutes before induction glycopyrrolate (0.01 mg/kg IM or SC) doesn't pass through the placental barrier
• Induction: Zoletil^(R) 7-10 mg/kg IM
• Perfusion: Ringer lactate (5 mL/kg per hour)
• Place animal in supine position as late as possible (light inclination on the side preferable)
• Mask oxygenation or intubation
• Once newborns are delivered, anesthesia of the mother can be deepen
• Care to newborns:
• If respiratory depression: doxapram + oxygen therapy
• If bradycardia: atropine 0.04 mg/kg IM
• If mother in state of chock: keep placenta for it will provide a blood supplement to newborns

Female cat ovariectomy

Zoletil^(R) is an anesthetic agent of choice for this type of procedures as it is very convenient to use:

• Easy to administer by IM
• Highly safe anesthetic agent for the patient
• A maintenance protocol is possible, if surgical procedure is to be extended (e.g. pregnancy or metritis)
  Zoletil^(R) has no cumulative toxicity so it can be re-injected

RECOMMENDED PROTOCOL

• Premedication: 15 minutes before induction glycopyrrolate (0.01 mg/kg IM or SC) or atropine (0.05 mg/kg SC)
• Induction: Zoletil^(R) 7-10 mg/kg IM
• Maintenance:Zoletil^(R) 2.5 mg/kg IM if needed

Bone surgery

Intramedullary fixation

When inhalation anesthesia is not possible, Zoletil^(R) can be indicated for long procedures:

• Brings an efficient and safe approach to performing basic bone surgery anesthesia
  Zoletil^(R) has no cumulative toxicity
  Zolazepam is quickly eliminated
• An instantaneous muscle relaxation is observed

RECOMMENDED PROTOCOL

• Premedication: 15 minutes before induction glycopyrrolate (0.01 mg/kg IM or SC) or atropine (0.05 mg/kg SC)
• Induction: Zoletil^(R) 10-15 mg/kg IM
• Maintenance: Zoletil^(R) 5-7 mg/kg IM
• Note: As Zoletil^(R) shows mild analgesic effects, adequate management of pain should be performed (NSAIDs, opioids)

 

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

 

Zoletil 50 Rx

G: Per vial w/ powder: Tiletamine HCl 125 mg, zolazepam base 125 mg. Per solvent vial: Sterilized water for inj 5 mL, reconstituted soln 50 mg/mL.
A: Zoletil 50 is a general injectable anesthetic agent. Tiletamine is a dissociative anesthetic agent. Zola­ze­pam is a sedative, an anxiolytic and a muscle relaxant. It enhances the tiletamine depression of the CNS. It also prevents seizures due to tiletamine and improves both muscle relaxation and recovery from anesthesia. Zoletil 50 produces a state of unconsciousness that has been referred to as dissociative because it appears to selectively interrupt association pathways to the brain. Depen­ding on the animal species, analgesia persists after the anesthetic effect has subsided. Pharyngeal and laryngeal reflexes remain intact. Cranial nerves and spinal reflexes remain intact. Consequently, the animal’s eyes remain open and the animal can swallow, move its tongue, chew, blink its eyelids and move its limbs during the anesthesia. The actions of Zoletil 50 can be summarized as follows: Catalepsy: Rapid, w/out agitation, followed by muscular relaxation. Analgesia: Immediate super­ficial analgesia, moderate visceral analgesia. Sur­gi­cal anesthesia: With muscular relaxation, persist­ence of laryngeal, pharyngeal and palpebral reflexes, no depression of respiratory center, possibi­lity of salivation.
I: Induction of anesthesia prior to inhalants or as a sole anesthetic agent for a wide variety of diagnosis and short duration surgical procedures of minor severity in cats, dogs and many wild and exotic animals.
D: Premedication – Atropine sulfate: Dogs- 0.1 mg/kg by SC, 15 mins before inj of Zoletil. Cats – 0.05 mg/kg by SC, 15 mins before inj of Zoletil. Induction – Mix extemporaneously the contents of the powder vial w/ the solvent. By IM – Loss of righting reflex in 3-6 mins. By IV – Loss of righting reflex on <1 10-15="" 100="" 10="" 30="" 5="" 7-10="" 7.5="" 72="" additional="" and="" anesthesia:="" be="" both="" bw.="" bw="" by="" can="" cats-="" cats="" cumulative="" dogs-="" dogs="" dosage="" dose="" doses="" ed.="" effect="" examination:="" examination="" exceed="" has="" im="" in="" initial="" injected="" iv="" kg="" lethal="" maximal="" mg="" min.="" minor="" no="" not="" of="" reinject="" safe="" shld="" short="" should="" species="" strong="" surgery:="" surgery="" that="" the="" to="" total="" varies="" w=""> non-domestic animals

. Duration of anesthesia: 20-60 mins according to dosage. Recovery: Analgesia has a longer duration than surgical anesthesia. Return to normal is progressive (2-6 hrs) and quiet, provid­ed that noise and light are avoided. Recovery can be longer in case of overdosing in fat or old animals. CI: Refer to product literature for further informa­tion.
P: Salivation is occasionally observed and can be controlled by administration of anticholinergic drugs, such as atropine, before anesthesia. Re­duce dose when other anesthetic agents are used.
Pr: Vial 10 mL + 1 solvent (5 mL) per box.
VR-2831 2012-04-03 125 mg/125 mg

 

 

 

 

REFERENCES
http://www.slideshare.net/kkrimetz/rat-anesthesia

1163. Animal activist has 48 dogs

Nov 13, 2013

The lady in her 30s transported one 9-year-old Husky and the owner to me. The Husky had 3 small circum-anal tumours and had been licking his tail underside till it stained dark brown with saliva. "It is good you come early as the 3 tumours are easier to excise," I said to the owner (a lady in her 50s). "Most owners come when the tumours are massive and difficult to operate. Have you seen such cases in the Toa Payoh Vets website, dogs -  male dog problems?"

"It is my daughter who asks to bring the dog here," she laughed. I scheduled surgery on this Friday. "

As for the transport lady, she was not full-time but was subcontracted. "Now I am all alone looking after 48 dogs. There were over 70 in the kennel in Pasir Ris."

"Are you from Madam Wong's kennels?" I asked.
"No, I rented the kennel space to save the street dogs. I have to earn some money to pay for the feeding of these dogs."

She gets less expensive dog food from suppliers, food about to expire. As she had lost her job, I don't know how she can continue feeding the 48 dogs. As for big pet shops, she had to acknowledge their contribution by putting their names in her webpage. "I don't have a webpage," she said.

"How about facebook?" I asked.
"No," she said. "Singaporeans wanting to abandon their dogs will dump them with me. I can't have the webpage."

Nowadays, many organised animal shelters in Singapore have terminated their hotline as the volunteers get abused in not accepting dogs that owners want to give up.  
   

1162. Kidney stones are rare in dogs

Silkie Terrier, F, spayed, 13 years
Fed dry food + bread since 5 years of age (adopted from another owner who migrated).


2 days ago, presented with vomiting and diarrhoea. I treated and advised blood tests and X-rays if the symptoms persisted. The dog came back yesterday, "dying" according to Dr Daniel who got the X-ray and blood tests done.

A rare case of kidney stones in 2 kidneys. Dogs usually suffer from bladder stones. No urine tests done. 

Blood urea and creatinine are extremely high. The dog vomits dark brown fluid in the crate and has heavy abdominal breathing as at 11.14 am Nov 13, 2013 when the lady owner came to visit as I phoned her to say that the dog was suffering in pain and was on the last leg of his life. The dog vomited white froth on the reception room floor.

The owner will bring home for today and had decided on euthanasia later in the day.