Sep 20, 2015
Recently, I had two over 70s male retirees who spoke to me:
1. A man whose shares pay him a $9,000 interest a month and he lived in a big house. He had only a Secondary one education and became a police constable. He became a businessman selling what was needed in small undeveloped countries like Papua New Guinea. There was no future in the police force as he was not a graduate. He built relationships with the natives and travelled most of the time.
I met him because the breeder packaged her Schnauzer sale with 3 free vaccinations. Otherwise, convenience and proximity would mean he would go to the nearest clinic in North Singapore.
"Anyway, the clinic there wanted me to pay more to consult the senior vet," he complained about the junior vets who were present to treat his other dogs.
"May I be frank with you?" he asked me in later visits after his female Schnauzer was spayed and I had drafted a letter for him to the Vietnamese embassy. "I cannot write very well as I studied up to Sec 1," he said. This letter was to inform the embassy that the ICA (Immigration and Control Authority) at the Singapore Airport did not have interpreters as stated in the newspaper. His Asian wife who came to visit him, before he married her, was detained and sent back on the next plane. "She is a good girl but she could not speak Mandarin or English. So, the ICA put her in a detention cell at the airport overnight and sent her home by the next plane."
He thanked me for drafting the letter and was frank with me about my practice at Toa Payoh Vets. Other vets have very long queues and waiting lines or several branches. My location in an industrial park did not inspire confidence and was inconvenient. So he said: "You wasted your time over the last 40 years at this industrial park, a god-forsaken place."
2. The retiree had worked for an airline dealing with stocks and shares on behalf of the airline. He came with his young adult daughter whose hyperactive dwarf hamster was losing weight and now was scratching her right face. It was an impacted pouch and right lip commissue ulcer. I evacuated the pouch and advised 10 seeds and pellets a day instead of a full bowl.
"Do you intend to work till you die?" the father asked me. He was 63 years old but had retired to smell the roses.
"I am self-employed and I enjoy my work," I consulted usually in the mornings usually 7 days a week. I ought to be smelling the roses, wake up late on weekends.
Sunday, September 20, 2015
Saturday, September 19, 2015
2301. Lip commissure ulcers in a hyperactive dwarf hamster and a syrian hamster
Saturday Sep 1, 2015
Bright sunny day with clouds greyed by the haze coming from the forest fires in Sumatra. I dare not exercise in the public park for fear of breathing in the micro particles.
Today, I have another case of two. Coincidences. 2 hamsters with lip commissures
CASE 1.
2 sisters brought in Haku (white in Japanese), 4-month-old Syrian hamster.
"Sure does not look white at all," I said. "It is more a tricolor."
"The sides of the mouth have bleeding. Sometimes they heal and come back again."
The hamster wriggled and turned and even bit the lady owner. She had to wash her hands.
"I need a bit of gas anaesthetic to check the mouth and trim the lower teeth," I asked permission from the owner as anaesthesia can be risky. "Without sedation, I can't do a proper examination and trim the teeth!"
She could see the hamster was extremely firsky.
Video: Two lower divergent teeth trimmed off by 3 mm. Upper teeth trimmed 1 mm to even them.
Lip commissures ulcerated at 3 mm across, cleaned with disinfectant.
Cheek pouch surprisingly empty but clean and not inflamed.
CASE 2.
I saw this hyperactive dwarf hamster 4 days ago for a very itchy body. I got the hairs clipped and there was a big wound on the back spinal area. This could be bacterial or fungal infection. I gave the medication to wash the skin. Now, he is scratching his left cheek again. I call him the most hyperactive dwarf hamster.
"He still weighs 40 g, same as 4 days ago," I said. "There is a yellow pus on the right cheek commissure."
The daughter had come. She phoned her mum which area was itchy. It was the right side under the neck. I could see inflamed skin around the right cheek pouch. There was an impacted cheek pouch. Lots of seeds were fished out.
"Ration the hamster to 10 'seeds and pellets a day," I advised. "He likes to hoard and his right cheek pouch was bulging full with seeds." I got the seeds out.
Video
Lip commissures are common in some dwarf hamsters. As to the cause, it is hard to say. Traumatic injury from sharp sunflower seeds? Gripping iron wires or metallic things?
Bright sunny day with clouds greyed by the haze coming from the forest fires in Sumatra. I dare not exercise in the public park for fear of breathing in the micro particles.
Today, I have another case of two. Coincidences. 2 hamsters with lip commissures
CASE 1.
2 sisters brought in Haku (white in Japanese), 4-month-old Syrian hamster.
"Sure does not look white at all," I said. "It is more a tricolor."
"The sides of the mouth have bleeding. Sometimes they heal and come back again."
The hamster wriggled and turned and even bit the lady owner. She had to wash her hands.
"I need a bit of gas anaesthetic to check the mouth and trim the lower teeth," I asked permission from the owner as anaesthesia can be risky. "Without sedation, I can't do a proper examination and trim the teeth!"
She could see the hamster was extremely firsky.
Video: Two lower divergent teeth trimmed off by 3 mm. Upper teeth trimmed 1 mm to even them.
Lip commissures ulcerated at 3 mm across, cleaned with disinfectant.
Cheek pouch surprisingly empty but clean and not inflamed.
CASE 2.
I saw this hyperactive dwarf hamster 4 days ago for a very itchy body. I got the hairs clipped and there was a big wound on the back spinal area. This could be bacterial or fungal infection. I gave the medication to wash the skin. Now, he is scratching his left cheek again. I call him the most hyperactive dwarf hamster.
"He still weighs 40 g, same as 4 days ago," I said. "There is a yellow pus on the right cheek commissure."
The daughter had come. She phoned her mum which area was itchy. It was the right side under the neck. I could see inflamed skin around the right cheek pouch. There was an impacted cheek pouch. Lots of seeds were fished out.
"Ration the hamster to 10 'seeds and pellets a day," I advised. "He likes to hoard and his right cheek pouch was bulging full with seeds." I got the seeds out.
Video
Lip commissures are common in some dwarf hamsters. As to the cause, it is hard to say. Traumatic injury from sharp sunflower seeds? Gripping iron wires or metallic things?
Friday, September 18, 2015
2300. The 17-year-old Shih Tzu barked and barked the whole night.
Sep 17, 2015
The parents came yesterday after phoning me to confirm that the urn was ready the day after euthanasia and cremation. The dog was put to sleep as he barked the whole night every night. The parents had to work but they could not sleep.
"We tried your medication for the past 5 weeks," the mum said. "But he became groggy and could not go to pee. In any case, it was not very effective."
The young adult son, now 25 years old was very upset and wanted the urn as soon as possible. So the parents had phoned me twice.
"How old was your son when he got this Shih Tzu as a puppy?" I asked.
"He was in Primary 6," the mum said. "At 12 years of age."
"The dog has been his best friend for 17 years and he was very sad."
The parents came yesterday after phoning me to confirm that the urn was ready the day after euthanasia and cremation. The dog was put to sleep as he barked the whole night every night. The parents had to work but they could not sleep.
"We tried your medication for the past 5 weeks," the mum said. "But he became groggy and could not go to pee. In any case, it was not very effective."
The young adult son, now 25 years old was very upset and wanted the urn as soon as possible. So the parents had phoned me twice.
"How old was your son when he got this Shih Tzu as a puppy?" I asked.
"He was in Primary 6," the mum said. "At 12 years of age."
"The dog has been his best friend for 17 years and he was very sad."
2299. Unbelieveable story. The sudden death of a retiree who was certified healthy
Sep 18, 2015
The Primary Production Department employee retired at 55 years of age in the old days some 20 years ago. He worked in the Extension Centre dealing with pigs and poulty. One day, he came to see the vet who had his practice in North Singapore.
"I have just passed my health screening test including threadmill. I am certified fit and healthy!". He was still interested in animal husbandry and borrowed a book from the vet.
As he left to go home, the vet joked: "Give me a 4-digit number to buy the 4-D lottery!"
"Nonsense, you may pass away first," he said to the private vet.
The next day, his son phoned the vet to say that his father had died at night.
"It could be an aneurysm (rupture of the blood vessel)," I said. "He could have gone for the threadmill test and over-exerted." Nobody knows the cause of his sudden death.
The Primary Production Department employee retired at 55 years of age in the old days some 20 years ago. He worked in the Extension Centre dealing with pigs and poulty. One day, he came to see the vet who had his practice in North Singapore.
"I have just passed my health screening test including threadmill. I am certified fit and healthy!". He was still interested in animal husbandry and borrowed a book from the vet.
As he left to go home, the vet joked: "Give me a 4-digit number to buy the 4-D lottery!"
"Nonsense, you may pass away first," he said to the private vet.
The next day, his son phoned the vet to say that his father had died at night.
"It could be an aneurysm (rupture of the blood vessel)," I said. "He could have gone for the threadmill test and over-exerted." Nobody knows the cause of his sudden death.
2298. Referral. A 13-year-old cross bred had a "water-melon" lump
Sep 18, 2015
I had laksa with this practising 76-yerar-old senior vet at Potong Pasir this morning. He would be opening a vet clinic in Johor and decided to focus on surgery.
"Many young vets do not want to perform complicated surgeries," he said. "So they will refer to others."
"That's true even in Yangon," I said. "One experienced vet who had worked in Singapore got all the surgeries referred to by the other vets. Even in Singapore too."
"Swee also wanted to refer one case of a dog with a very large cyst, as big as a water melon to other vets," he recounted a 13-year-old cross bred dog that the owner wanted him to treat. "I am an old vet and I refer to a young vet to do the surgery!" This old vet practised vet surgery for over 50 years but this was the first time he encountered such a large abdominal cyst.
Once I saw him operating to remove a gigantic tumour on the submandibular area of an old dog. The tumour was the size of an orange. Electro-surgery and keeping a lookout for bleeders, he removed this tumour. But the abdominal tumour was a large water-melon size.
"Did you draw out any fluid after inserting a needle?" I asked.
"No fluid," he said. "There was a thick wall and it was enveloped by some lace-liked tissue (the mesentery).
"It is a matter of common sense. I dissect slowly using electro-surgery. I reached a drainage tube. Suddenly, thick viscous fluid shot out, deflating the lump!"
"This would be an abdominal cyst that grows slowly over 10 years," I recalled my Taenia tapeworm from sheep to dog transmission lectures in Glasgow University some 50 years ago. "It could be a tapeworm cyst. Cysticercus species."
"There were many smaller cysts and it would be too risky to remove every one." he said. "The fluid inside the cyst was not clear but thick and cloudy."
"These would be the other younger cysts developing," I said.
"After the surgery, the dog was jumping and running normally," the vet laughed happily. "The owner was very happy!"
And to think that his senior nurse who had been with him for many years, asked him not to operated and to refer to other vets or the expatriate specialist. I just cannot understand. Some 50 years ago, when I was in National Service full time in 1977, this vet operated on a Patent Ductus Arteriosis in a SAF Provost Unit guard dog that would be put to sleep as it was lethargic and useless. There was no sophisticated hospital equipment like the automatic ventilator to prevent the lungs deflating when the chest is cut open.
I assisted by pressing the anaesthetic vet while he located the shunting blood vessel and ligated it. No young vet would do this surgery. He was 38 years old and had his own practice and at least 10 years of experience. I was 27 years and doing my National Service, with no canine surgical experience.
A sound knowledge of anatomy is needed. The dog recovered and was back on guard dog duty.
I had laksa with this practising 76-yerar-old senior vet at Potong Pasir this morning. He would be opening a vet clinic in Johor and decided to focus on surgery.
"Many young vets do not want to perform complicated surgeries," he said. "So they will refer to others."
"That's true even in Yangon," I said. "One experienced vet who had worked in Singapore got all the surgeries referred to by the other vets. Even in Singapore too."
"Swee also wanted to refer one case of a dog with a very large cyst, as big as a water melon to other vets," he recounted a 13-year-old cross bred dog that the owner wanted him to treat. "I am an old vet and I refer to a young vet to do the surgery!" This old vet practised vet surgery for over 50 years but this was the first time he encountered such a large abdominal cyst.
Once I saw him operating to remove a gigantic tumour on the submandibular area of an old dog. The tumour was the size of an orange. Electro-surgery and keeping a lookout for bleeders, he removed this tumour. But the abdominal tumour was a large water-melon size.
"Did you draw out any fluid after inserting a needle?" I asked.
"No fluid," he said. "There was a thick wall and it was enveloped by some lace-liked tissue (the mesentery).
"It is a matter of common sense. I dissect slowly using electro-surgery. I reached a drainage tube. Suddenly, thick viscous fluid shot out, deflating the lump!"
"This would be an abdominal cyst that grows slowly over 10 years," I recalled my Taenia tapeworm from sheep to dog transmission lectures in Glasgow University some 50 years ago. "It could be a tapeworm cyst. Cysticercus species."
"There were many smaller cysts and it would be too risky to remove every one." he said. "The fluid inside the cyst was not clear but thick and cloudy."
"These would be the other younger cysts developing," I said.
"After the surgery, the dog was jumping and running normally," the vet laughed happily. "The owner was very happy!"
And to think that his senior nurse who had been with him for many years, asked him not to operated and to refer to other vets or the expatriate specialist. I just cannot understand. Some 50 years ago, when I was in National Service full time in 1977, this vet operated on a Patent Ductus Arteriosis in a SAF Provost Unit guard dog that would be put to sleep as it was lethargic and useless. There was no sophisticated hospital equipment like the automatic ventilator to prevent the lungs deflating when the chest is cut open.
I assisted by pressing the anaesthetic vet while he located the shunting blood vessel and ligated it. No young vet would do this surgery. He was 38 years old and had his own practice and at least 10 years of experience. I was 27 years and doing my National Service, with no canine surgical experience.
A sound knowledge of anatomy is needed. The dog recovered and was back on guard dog duty.
Thursday, September 17, 2015
2297. A 13-year-old male cat and dog came from North Singapore
Wed Sep 16, 2015
Unusual twos. Two cases from the owners of a 13-year-old cat and a 13-year-old dog from the same neighbourhood in North Singapore in successive days. As Singaporeans prefer proximity, I rarely have one case from North Singapore during the past years. The location is a 30-minute drive away and it has nearer clinics than Toa Payoh Vets.
Vet 1 from the same clinic in North Singapore treated both cases from owners unrelated and unknown to one another. So I was much surprised at the coincidences of two sick 13-year-olds.
CASE 1 ON SEP 15, 2015
13-YEAR-OLD CAT
The first case was a cat not eating and lethargic. I got a blood test done as Vet 1 had done X-rays and ultrasound but was not given the permission to do X-rays. The cat did not recover and so the owner consulted me for a second opinion. She consented to X-rays which showed a low platelet count indicating toxicity causing the left kidney to be painful. I palpated the left kidney and the cat meowed in protest, telling me that it is painful. For normal kidneys, the cat will not react to palpation.
TREATMENT - Dental scaling (gingivitis on back teeth and tartar). Left ear irrigation. IV drip x 1 bottle Hartmans with antibiotic and painkiller. Overnight inpatient. The next day, the cat ate and was meowing happily. Went home.
In retrospect, the owner recalled a possible ingestion of commercial ear drops purchased from the pet shop as the owner noted that the old cat pawed at the ear drops after she had put inside the left ear. The cat could have been poisoned resulting in ear pain. This was not obvious without the blood test. Cats are very sensitive to chemicals and pain.
Lethargic and anorexic for 7 days. The owner had purchased ear drops to treat the left ear discharge since April 2015. Treated by Vet 1. Ok. Problem came back in June and so she decided to buy the pet shop's ear drops which irritated the cat around 7 days before the sickness. The likely cause could be the chemical toxicity affecting the left kidney which has a radio-dense stone of 3 mm in diameter.
No hairball snacks and treats
Only First Choice For Senior Cats
I warned that the left kidney had a stone which could cause kidney pain and swelling later. As at Sep 30, 2015, the cat was eating and drinking and was active. There was no ear discharge.
CASE 2
The old dog's veterinary bills amounted to a large sum and so the brother who works in the same building as Toa Payoh Vets referred the sister to me.
"As the dog had heart, kidney and prostatic diseases, the bills will add up," I said to the brother today. "Chronic diseases tend to cost much to treat." Many Singaporean owners only look at the absolute amount and would pronounce to the world: "This vet is expensive and cut-throat."
URETHROSTOMY DONE yesterday.
"Very high risk of death on the op table," I said to the brother and sister as the chihuahua had this loud heart murmurs of Grade 4 confirmed by Vet 1.
"50%?" the brother said.
"Hard to say it is 50:50," I would not be precise as the dog's bladder swelled up to a mango size.
Vet 1 had taken out 15 ml of the urine from the bladder by cystocentesis and given a Tardak injection to reduce the massive prostatic swelling which could cause urination problems. Two weeks ago, he had given one and the dog had no problem urinating.
On going home, the dog just could not pee and some urine dribbled out despite treatment by Vet 1. This appeared to have shaken the confidence of the owner and so the brother asked her to consult me.
The bladder ballooned.
"It is death if you don't operate. It may be death if you opeerate," the brother told the sister. There was no time to waste.
URETHROSTOMY
Weight 3.5 kg. T=37.8C. Cyanotic mucous membrane.
1. I gave 1/2 tablet Fortekor 5 orally and inject frusemide 1 ml SC and waited for 1.5 hours. The bladder had swollen to a ballon.
2. IV drip. IV baytril and tolfedine.
3. Atropine 0.6 ml SC
4. No sedatives
5. Isoflurane gas only.
6. Catheter blocked from behind the os penis where the stone was lodged. Marker pen to draw the length of catether at the obstruction. This confirms that the enlarged prostate was not the cause of this anuria as the prostate could be having tumours. In any case, Vet 1 had given Tardak injection the day before.
7. I electro-incise behind the os penis and pre-scrotal for around 3cm length. A large 4mm x 4mm brown stone was seen. 3 smaller ones of 2 mm across were seen.
8. I located the urether which was around 1.3 mm in diameter as my assistant compressed the bladder, squirting out the urine.
9. I inserted the cat catheter into the narrow urethra and stitched up the 4 holes.
10. I stitch skin and muscles to either side so as not to close up the wound in front of the catheter.
The whole process of start of anaethesia by mask to completion of stitching took around 40 minutes. The dog was alive and woke up as soon as the gas was taken off. This was a big relief to me.
COMMENTS
1. A vet book mentioned minimal sedation and local anaesthetic for dogs with kidney or serious health problems. In this case, the heart disease was bad. So, I did not give sedation by injection.
2. In normal urethrostomy, the catether can be seen as the urethra is incised 2-4 cm since it is placed inside from the penile tip. In this case, I had to open behind the obstruction and so was not able to view the very narrow 1.3 mm cathether of this chihuahua. I used the squirting urine to locate it and anchor the cat's cathether.
3. Today, 16 hours post-op, the dog is active and alert.
4. I advise neutering in case the prostate swelled up more to obstruct urine flow, instead of Tardak injections regularly. The anaesthetic risks of dying are there.
5. Urine test and stone analysis need to be done as a minimum. I did not ask for blood test as the owner was not in favour of additional medical cost.
.
6. As to the need for regular weekly SC dialysis by Vet 1, I told the brother that he ought to have blood test to check on the kidneys and whether there is still renal failure. In the meantime the dog is given Hartmann's 250 ml SC once a week.
SEP 18, 2015
I sent the Chihuahua back on Day 2 but he licked his wound causing bleeding. There was another dog in the apartment wanting to play with him.
The dog came back and I saw a large pink purplish bruise on the right side of the scrotal area due to licking. As an in-patient, he had no distractions and was recuperating well. The owner wished to have him in-patient for the next 3 days. The catheter was still in place and the urine coming out looked clear. The dog is an in-patient now and will be given dialysis SC today.
The prostatic enlargement will cause urination problem later and Tardak injections may need to be given regularly. A neuter would be best but the owners have their worries about anaesthetic risks and so did not accept my advice. The neuter surgery is much shorter than this urethrostomy but the risks are still there. If the dog had been neutered at a young age, there will be no prostatic hypertrophy which could cause obstruction to the flow of urine.
During surgery, I noticed that the urine from the distended bladder did not flow freely after I removed the 4-mm x 4mm urethral stone. My assistant had to compress the bladder manually to release the urine. So, it is possible that the enlarged prostate or prostatic tumour will cause dysuria.
Neuter will be the best advice but the owners think of anaesthetic risks and death and so, nothing will be done till another dysuria episode comes.
FOLLW UP.
Sep 30, 2015
1. The dog is at home. He had been neutered under a 2nd general anaesthesia. Dr Daniel did the neuter on Sep 27, 2015. As this dog had swollen testicles, he did a scrotal ablation which involved removal of the scrotal sac as well and the testicles which may be having abnormal growth. Neuter removes the testosterone hormones which cause prostate enlargement (see X-ray) and require weekly Tardak injections. If the dog had been neutered at a young age, there would be no prostate enlargement but many young Singaporean dog owners believe it is "cruel" to neuter a dog.
There was the risk that this dog could die under the 2nd anaesthesia, being very old and in poor health. But he survived, much to the happiness of the young lady owner and family.
2. The stone analysis of the urethral stone was calcium oxalate. The two big stones are inside the bladder.
3. The blood test showed high urea and creatinine levels and low red blood cell count and haemoglobin. This confirms that the dog has chronic kidney disease and would need the twice a week dialysis. The owner now understands that the dog needs to be given the K/D diet. The dog ate a whole can but 6 hours later vomited some food. I advised that the dog, being thirsty due to kidney failure, not be given large amounts of water to drink at one time.
4. This case illustrates the need to patiently communicate with the family members regarding the costs and treatment of the heart, kidney and prostate diseases in this old Chihuahua. Medical costs are high in chronic disesease due to the various tests and procedures required. A perseverance to train the dog owner how to give the Prescription K/D diet to avoid more damage to the kidneys and to live longer finally pays off now. All the while, the owner feeds the dog hamburgers from McDonalds as he would not eat the K/D/
------------
URETHRAL OBSTRUCTION AND FIC IN CATS
1. URETHRAL OBSTRUCTION
1.1 Stablise the cat by decompressing the bladder in some cases, before catherisation. Do cystocentesis. Insert 25-G needle at 45 degrees towards the neck of the bladder. Not at 90 degrees or into the apex of bladder as bladder shrinks away freom the needle when urine is collected.
1.3 Massage penile tip for some time -around 10 minutes to express out the urethral plug and so avoid the need to catetherise. This does happen in some hh of her cases.
Unusual twos. Two cases from the owners of a 13-year-old cat and a 13-year-old dog from the same neighbourhood in North Singapore in successive days. As Singaporeans prefer proximity, I rarely have one case from North Singapore during the past years. The location is a 30-minute drive away and it has nearer clinics than Toa Payoh Vets.
Vet 1 from the same clinic in North Singapore treated both cases from owners unrelated and unknown to one another. So I was much surprised at the coincidences of two sick 13-year-olds.
CASE 1 ON SEP 15, 2015
13-YEAR-OLD CAT
The first case was a cat not eating and lethargic. I got a blood test done as Vet 1 had done X-rays and ultrasound but was not given the permission to do X-rays. The cat did not recover and so the owner consulted me for a second opinion. She consented to X-rays which showed a low platelet count indicating toxicity causing the left kidney to be painful. I palpated the left kidney and the cat meowed in protest, telling me that it is painful. For normal kidneys, the cat will not react to palpation.
TREATMENT - Dental scaling (gingivitis on back teeth and tartar). Left ear irrigation. IV drip x 1 bottle Hartmans with antibiotic and painkiller. Overnight inpatient. The next day, the cat ate and was meowing happily. Went home.
In retrospect, the owner recalled a possible ingestion of commercial ear drops purchased from the pet shop as the owner noted that the old cat pawed at the ear drops after she had put inside the left ear. The cat could have been poisoned resulting in ear pain. This was not obvious without the blood test. Cats are very sensitive to chemicals and pain.
Lethargic and anorexic for 7 days. The owner had purchased ear drops to treat the left ear discharge since April 2015. Treated by Vet 1. Ok. Problem came back in June and so she decided to buy the pet shop's ear drops which irritated the cat around 7 days before the sickness. The likely cause could be the chemical toxicity affecting the left kidney which has a radio-dense stone of 3 mm in diameter.
No hairball snacks and treats
Only First Choice For Senior Cats
I warned that the left kidney had a stone which could cause kidney pain and swelling later. As at Sep 30, 2015, the cat was eating and drinking and was active. There was no ear discharge.
CASE 2
The old dog's veterinary bills amounted to a large sum and so the brother who works in the same building as Toa Payoh Vets referred the sister to me.
"As the dog had heart, kidney and prostatic diseases, the bills will add up," I said to the brother today. "Chronic diseases tend to cost much to treat." Many Singaporean owners only look at the absolute amount and would pronounce to the world: "This vet is expensive and cut-throat."
URETHROSTOMY DONE yesterday.
"Very high risk of death on the op table," I said to the brother and sister as the chihuahua had this loud heart murmurs of Grade 4 confirmed by Vet 1.
"50%?" the brother said.
"Hard to say it is 50:50," I would not be precise as the dog's bladder swelled up to a mango size.
Vet 1 had taken out 15 ml of the urine from the bladder by cystocentesis and given a Tardak injection to reduce the massive prostatic swelling which could cause urination problems. Two weeks ago, he had given one and the dog had no problem urinating.
On going home, the dog just could not pee and some urine dribbled out despite treatment by Vet 1. This appeared to have shaken the confidence of the owner and so the brother asked her to consult me.
The bladder ballooned.
"It is death if you don't operate. It may be death if you opeerate," the brother told the sister. There was no time to waste.
URETHROSTOMY
Weight 3.5 kg. T=37.8C. Cyanotic mucous membrane.
1. I gave 1/2 tablet Fortekor 5 orally and inject frusemide 1 ml SC and waited for 1.5 hours. The bladder had swollen to a ballon.
2. IV drip. IV baytril and tolfedine.
3. Atropine 0.6 ml SC
4. No sedatives
5. Isoflurane gas only.
6. Catheter blocked from behind the os penis where the stone was lodged. Marker pen to draw the length of catether at the obstruction. This confirms that the enlarged prostate was not the cause of this anuria as the prostate could be having tumours. In any case, Vet 1 had given Tardak injection the day before.
7. I electro-incise behind the os penis and pre-scrotal for around 3cm length. A large 4mm x 4mm brown stone was seen. 3 smaller ones of 2 mm across were seen.
8. I located the urether which was around 1.3 mm in diameter as my assistant compressed the bladder, squirting out the urine.
9. I inserted the cat catheter into the narrow urethra and stitched up the 4 holes.
10. I stitch skin and muscles to either side so as not to close up the wound in front of the catheter.
The whole process of start of anaethesia by mask to completion of stitching took around 40 minutes. The dog was alive and woke up as soon as the gas was taken off. This was a big relief to me.
COMMENTS
1. A vet book mentioned minimal sedation and local anaesthetic for dogs with kidney or serious health problems. In this case, the heart disease was bad. So, I did not give sedation by injection.
2. In normal urethrostomy, the catether can be seen as the urethra is incised 2-4 cm since it is placed inside from the penile tip. In this case, I had to open behind the obstruction and so was not able to view the very narrow 1.3 mm cathether of this chihuahua. I used the squirting urine to locate it and anchor the cat's cathether.
3. Today, 16 hours post-op, the dog is active and alert.
4. I advise neutering in case the prostate swelled up more to obstruct urine flow, instead of Tardak injections regularly. The anaesthetic risks of dying are there.
5. Urine test and stone analysis need to be done as a minimum. I did not ask for blood test as the owner was not in favour of additional medical cost.
.
6. As to the need for regular weekly SC dialysis by Vet 1, I told the brother that he ought to have blood test to check on the kidneys and whether there is still renal failure. In the meantime the dog is given Hartmann's 250 ml SC once a week.
SEP 18, 2015
I sent the Chihuahua back on Day 2 but he licked his wound causing bleeding. There was another dog in the apartment wanting to play with him.
The dog came back and I saw a large pink purplish bruise on the right side of the scrotal area due to licking. As an in-patient, he had no distractions and was recuperating well. The owner wished to have him in-patient for the next 3 days. The catheter was still in place and the urine coming out looked clear. The dog is an in-patient now and will be given dialysis SC today.
The prostatic enlargement will cause urination problem later and Tardak injections may need to be given regularly. A neuter would be best but the owners have their worries about anaesthetic risks and so did not accept my advice. The neuter surgery is much shorter than this urethrostomy but the risks are still there. If the dog had been neutered at a young age, there will be no prostatic hypertrophy which could cause obstruction to the flow of urine.
During surgery, I noticed that the urine from the distended bladder did not flow freely after I removed the 4-mm x 4mm urethral stone. My assistant had to compress the bladder manually to release the urine. So, it is possible that the enlarged prostate or prostatic tumour will cause dysuria.
Neuter will be the best advice but the owners think of anaesthetic risks and death and so, nothing will be done till another dysuria episode comes.
FOLLW UP.
Sep 30, 2015
1. The dog is at home. He had been neutered under a 2nd general anaesthesia. Dr Daniel did the neuter on Sep 27, 2015. As this dog had swollen testicles, he did a scrotal ablation which involved removal of the scrotal sac as well and the testicles which may be having abnormal growth. Neuter removes the testosterone hormones which cause prostate enlargement (see X-ray) and require weekly Tardak injections. If the dog had been neutered at a young age, there would be no prostate enlargement but many young Singaporean dog owners believe it is "cruel" to neuter a dog.
There was the risk that this dog could die under the 2nd anaesthesia, being very old and in poor health. But he survived, much to the happiness of the young lady owner and family.
2. The stone analysis of the urethral stone was calcium oxalate. The two big stones are inside the bladder.
3. The blood test showed high urea and creatinine levels and low red blood cell count and haemoglobin. This confirms that the dog has chronic kidney disease and would need the twice a week dialysis. The owner now understands that the dog needs to be given the K/D diet. The dog ate a whole can but 6 hours later vomited some food. I advised that the dog, being thirsty due to kidney failure, not be given large amounts of water to drink at one time.
4. This case illustrates the need to patiently communicate with the family members regarding the costs and treatment of the heart, kidney and prostate diseases in this old Chihuahua. Medical costs are high in chronic disesease due to the various tests and procedures required. A perseverance to train the dog owner how to give the Prescription K/D diet to avoid more damage to the kidneys and to live longer finally pays off now. All the while, the owner feeds the dog hamburgers from McDonalds as he would not eat the K/D/
------------
URETHRAL OBSTRUCTION AND 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 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 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
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. Her favourite is given.
NASAL TUBE FEEDING OF CATS
She said it is easy in her practice with the nurse holding the cat. But given sedation if necessary.
Can email to her if you have queries.
Tuesday, September 15, 2015
2296. Eye injury in a pug and prosthetic eye - email diagnosis is unreliable
Hi,
As
spoken to you earlier regarding my dog eye. I have attached an image
of how bad his eye is, currently his eye is cover by blood clot as
yesterday was in minor
bleeding compare to his
first time bleeding. please do let me know whether you guys provide
fake eye ball implant. By the way this coming Thursday morning he will
be
going to remove his eye from a vet from jurong. If you do have solution
to cure his eye, please don't hesitate, contact me asap. Thank you so
much for your
concern & time.
Best regards,
V
------------------------------------------------
EMAIL REPLY FROM DR SING K Y
Sep 15, 2015
Subscribe to:
Posts (Atom)