To succeed in life and in business, one has to know what to do and to work hard. There is no short cut to success. I will illustrate this interesting case.
Mr Oh - A prospective Buyer's Agent - The 30-year-old man
Mr Lee - A prospective Seller's Agent - The 72-year-old man
Goods in demand in Myanmar - a brand-name multi-vitamins
What Mr Oh wanted from Mr Lee was a large number of multi-vitamins without the box, an analysis certificate and quotation. He said: "I could get the vitamins from a Singapore importer but his prices are high."
What Mr Lee wanted from Mr Oh was his quoted buying price and method of payment. He did now want to waste time providing quotes so that Mr Oh can use to underprice or force another Seller to bid lower. He would not provide an analysis certificate at his own expense. He would not provide the vitamins without a box as there would be damages and then claim from Mr Oh. He wanted full payment but Mr Oh offered to pay 50% deposit and 50% on delivery.
I could see that there was no point in doing business. "It is not easy to do this business," Mr Lee reiterated to me several times. I was not doing this business as I knew that a lot of time would be wasted wheeling and dealing. So I dropped the contacts. Then Mr Oh phoned me to follow up. I arranged for a meeting with Mr Lee at the last minute and asked Mr Lee to meet at Peninsula Plaza at 4 pm.
BE FLEXIBLE
1. Last-minute meetings are irritating to my friend Khin Khin when she has better things to do. She blasted me once when I arranged for her to meet the 72-year-old man (who has extensive trading contacts in China and Indonesia). She gave me a piece of her mind. For me, this is OK if I have the time.
2. The 72-year-old man asked me to drive him to the meeting. I obliged. There is no point saying to him that "you want the business, you go yourself." This is being inflexible.
3. The old man said he had to eat something as he was diabetic. The meeting was 4 p.m and we were late by 15 minutes. So I phoned Khin Khin and her contacts to explain the situation of delay and suggested a meeting at Funan Shopping Centre Food Court which is just a 5-minute walk from Peninsula Plaza. "No," Khin Khin said. "We meet at Peninsula Plaza. How long will you and the old man take to come?"
"It will be 2 hours later," I slammed down the phone. I had driven Mr Lee all the way from Clementi and here, Khin Khin and her contacts were not keen to meet nearby and have some drinks. Making a business contact is 90% entertainment rather than just straight talking about business.
BE RESPECTFUL
1. I really dislike Khin Khin saying "old man" when she could say Mr Lee. It is disrespectful in stating the obvious. Even "young man" may be condescending to somebody who is insecure and just starting out in business. Just address the business contact by his name. It is so simple and yet Khin Khin and her friend would not do it since they are younger. But not as young as spring chickens.
BE CLEVER WHEN ENCOUNTERING OLD DOGS IN BUSINESS
1. When Mr Lee had his roti prata, he told me that since he had come all the way, he should contact Mr Oh. I said: "Phone yourself, as I don't see any future in this business with the behaviour of the Sellers' agents." He phoned Khin Khin's friend, May Thet whom I had first introduced earlier. She was the one who knew Khin Khin and Mr Oh. May Thet said OK to meet at Peninsula Plaza. When Mr Lee and I arrived, May Thet pulled up a chair and said: "Welcome boss..."
This is where I said one has to be clever when encountering old dogs in business. The 72-year-old man replied: "If I am the boss, why do I have to come all the way with my goods to see you? You even refused to meet me at Funan Centre..."
LEAVE THE MEETING WHICH WILL NOT BE SUCCESSFUL
I left Mr Lee at Peninsula Plaza with the Seller's Agent and contacts. It would be an acrimonious meeting with no results. The old man would be brutally frank to teach these young people how to do business. I went to a shop that sells paintings. The proprietor cannot converse well with me in English but she has new paintings on sale. It would be such a pleasant time to spend looking at the work of the craftsmen selling their artwork.
Later, Mr Lee told me that he told Mr Oh to put $100 cash down while he would write a cheque for $1,000 since Mr Oh said he had a Singapore importer and would not really need Mr Lee's services. Mr Lee said that the "importer" was just a distributor or post man. Mr Oh declined the bet and left in an unhappy manner. That was what I predicted. No need brains to do it. As for Mr Lee, he told me he felt invigorated sparring with the Seller's agents as they knew nothing about the vitamin business.
I learnt some business tips such as "dumping" from the 72-year-old man by being hands on and though this business meeting was acrimonious, I was not involved in the unpleasant encounters. No business university can beat being hands on and meeting a brutally frank 72-year-old general trader with considerable experience. You just need to spend time with him and if he respects you, he will share his experiences and extensive network. You just have to read the situation and act wisely.
APPLICATION TO VETERINARY MEDICINE.
"Dumping" applies to veterinary medicine too. For example, pet shops in veterinary surgeries sell a brand of food at just cost-price by ordering in large quantities.
The importer has given the seller a 40% discount and recommends a 20% discount to consumers. If the pet shop operator sells at 35% discount, he gets many sales and in theory he will ask for more supplies. However, this is dumping and the importer will never supply him more as dumping is not sustainable in business in the long term for the manufacturer and importer.
Monday, November 29, 2010
257. The dog with white gums - continued
Low red blood cells, low haemoglobin and very low platelet count are life-threatening situations to the dog with the white gums. I followed up by phone call for the next 2 weeks for 3 occasions. The owner was quite happy that the dog was eating 4 times a day and her gums were pinker and would come in for another blood test on the 14th day after the first consultation.
Then on the 14th day (Friday), the dog vomited and so the owner texted me to cancel the appointment. Vomiting is a serious sign. The owner brought in the dog on a Saturday afternoon and she was given the IV drips and treatment. Blood and urine tests were done. "The dog bites me when I carry her," the owner said. I palpated the T/L spinal area and the dog wanted to bite me. The dog had normal rectal temperature and the gums had become pale. She was not eating.
Blood tests indicated that the red cells and haemogolbin levels were back to the low range of normal but would be considered normal. The platelet count was still low but not at 1. It was 120 (normal is 200 -500). A very high white cell count of 27,000 indicated a bacterial infection. The liver enzymes were very high too indicating hepatitis. Serum urea was high but creatinine was below normal. White cells and bacteria and blood were present in the urine tests. A few crystals of calcium oxalate.
Palpation: Spleen enlarged and could be felt like a long rectangular tongue transversing the abdomen. A large painful mass on left side behind the rib, of around 10cm x 4 cm would be the left kidney. Liver enlarged.
The owner visited the dog on Saturday afternoon. The dog seemed OK. No rectal temperature increase. Then on Saturday evening, the dog just passed away quietly at 7p.m. I phoned the owner who came.
"What's the cause of death?" her 2 friends asked me. "It is likely to be septicaemia from bacterial infection. The dog could have inhaled toxic dusts from the neighbour's ongoing renovation (acid and cement dust) for the past weeks." The dog's tongue was cyanotic and white. The spleen and left kidney were enlarged.
The dog had tumours based on ultrasound and these tumours could have spread to all over the body. It is hard to say without a post mortem. Direct Coomb's test was negative but this does not rule out autoimmune haemolytic anaemia. Thyroid function tests were done.
It was hard to save this old dog when she has internal tumours and a toxic dusty environment. Both could result in an autoimmune haemolytic anaemia and thrombocytopaenia.
The owner said good bye to the dog after arranging for cremation. There was not much I could say. She shook my hands and thanked me. This was one of my saddest cases in veterinary medicine as I could not prevent a second recent bereavement in her family.
Then on the 14th day (Friday), the dog vomited and so the owner texted me to cancel the appointment. Vomiting is a serious sign. The owner brought in the dog on a Saturday afternoon and she was given the IV drips and treatment. Blood and urine tests were done. "The dog bites me when I carry her," the owner said. I palpated the T/L spinal area and the dog wanted to bite me. The dog had normal rectal temperature and the gums had become pale. She was not eating.
Blood tests indicated that the red cells and haemogolbin levels were back to the low range of normal but would be considered normal. The platelet count was still low but not at 1. It was 120 (normal is 200 -500). A very high white cell count of 27,000 indicated a bacterial infection. The liver enzymes were very high too indicating hepatitis. Serum urea was high but creatinine was below normal. White cells and bacteria and blood were present in the urine tests. A few crystals of calcium oxalate.
Palpation: Spleen enlarged and could be felt like a long rectangular tongue transversing the abdomen. A large painful mass on left side behind the rib, of around 10cm x 4 cm would be the left kidney. Liver enlarged.
The owner visited the dog on Saturday afternoon. The dog seemed OK. No rectal temperature increase. Then on Saturday evening, the dog just passed away quietly at 7p.m. I phoned the owner who came.
"What's the cause of death?" her 2 friends asked me. "It is likely to be septicaemia from bacterial infection. The dog could have inhaled toxic dusts from the neighbour's ongoing renovation (acid and cement dust) for the past weeks." The dog's tongue was cyanotic and white. The spleen and left kidney were enlarged.
The dog had tumours based on ultrasound and these tumours could have spread to all over the body. It is hard to say without a post mortem. Direct Coomb's test was negative but this does not rule out autoimmune haemolytic anaemia. Thyroid function tests were done.
It was hard to save this old dog when she has internal tumours and a toxic dusty environment. Both could result in an autoimmune haemolytic anaemia and thrombocytopaenia.
The owner said good bye to the dog after arranging for cremation. There was not much I could say. She shook my hands and thanked me. This was one of my saddest cases in veterinary medicine as I could not prevent a second recent bereavement in her family.
Thursday, November 25, 2010
256. Autoimmune Haemolytic Anaemia (AIHA) in Dogs
Today, Thursday at 9.30 am, the lady owner will be bringing the Miniature Schnauzer with white gums, 2 weeks after treatment. It is 4.36 am now and I am reviewing the case of this dog. A case of the dog with white gums. The first report is at:
http://www.kongyuensing.com/folder5/201006220very-low-platelet-count-Schnauzer-10years_anorexic-ToaPayohVets.htm
So far, the lady said that the dog's gums had become pinker. The dog is eating and drinking and passes normal stools and urine. Her only complaint was that the dog had this panting throughout the day during the past 2 weeks. She said: "She may be feeling some pain."
Well, the dog did have a very painful slipped disc when I first checked her. She also had a painful bladder area on palpation.
What is the cause of this panting? Is the old dog with white gums suffering from a form of an autoimmune haemolytic anaemia (AHA)? In AHA, the dog's red blood cells are produced normally but its abnormal antibodies which are needed to destroy bacteria or viruses, start destroying the red blood cells. So, the dog has low red blood cells and suffers from anemia.
In AHA, the dog also has low numbers of platelets and suffers from thrombocytopenia. The platelets in the blood form clots when blood vessels are cut or broken. If the dog has low platelet count, there will be uncontrolled bleeding. AHA in dogs is similar to haemopilia in people.
SYMPTOMS
Anaemia. Pale or white gums, conjunctiva and later yellow instead of normal pink to red colour. So the dog is lethargic as it has low levels of oxygen in the tissues and brain.
Jaundice. The liver removes the damaged red cells. The breakdown products causes a yellow colour of gums, conjunctiva and skin.
Bleeding from the nose or blood in the stools due to low platelet count. Takes a longer time for bleeding to stop.
Heart beats faster to bring oxygen to the tissues and brain.
DIAGNOSIS
1. COOMBS TEST is used to check for antiglobulins (autoantibodies). Nearly 98% of human patients with AIHA have a positive direct Coombs test (also known as direct antiglobulin test or DAT). A positive DAT means that the red blood cells are coated with the red blood cell autoantibodies. Patients may only have a positive direct Coombs test during disease flares and not at all times. There is also the Coombs Negative AIHA as a result of vaccinations or other medical conditions and the patient is mis-diagnosed as having other types of anemia or non-immune haemolytic anemia.
2. BONE MARROW BIOPSY
AIHA may be either regenerative or non-regenerative as determined by a lab examination of a blood sample and/or bone marrow biopsy. Regenerative anaemia - increased numbers of large immature red blood cells (reticuloycytes). Non-regenerative anaemia - anaemia lasting >5 days with low reticulocytes; the immature red cells are made but are destroyed in the bone marrow by the dog's own immune system.
As Vet 1's blood results did not include platelets (IDDEX machine had advised another blood test), so there was no earlier blood test history in relation to RBC, HB and platelets.
Dogs with chronic AIHA take many weeks to show clinical signs as in this case.
A bone marrow biopsy is used to distinguished between non-regenerative AIHA and cancer or other causes of non-regenerative haemolytic anaemia. But few vets do this bone marrow biopsy and diagnose the dog with chronic non-regenerative AIHA as suffering from blood cancer.
IN THE CASE OF THE DOG WITH WHITE GUMS, it was difficult to collect the urine for analysis of the presence of haemoglobin in the urine. The dog was in great pain and I stopped catherisation of the urethra for urine. She peed the normal yellow urine instead of the dark red urine in AHA.
CAUSES
Genetic or environmental factors. The latter include infections, drugs, poisons, bee stings and vaccines. Various neoplasms, systemic lupus erythematosus and canine hypothyroidism.
The dog had not been vaccinated for the past few years and so vaccination would not be the cause. The dog was recently taken outdoors after living in the apartment for most of her life. Infections could be the cause.
Some indications of infections include ulcers at the back of the tongue on the left side. (I took a picture 24 hours after IV treatment when I examined the tongue and tonsills). At the first consultation, the dog wanted to bite me when I palpated the enlarged left submandibular and popliteal lymph nodes.
Tumours. Since the dog had been losing weight of 25% for the past 4 weeks (from 5kg to 4kg), it could be suffering from internal tumours, e.g. in the spleen, pancreas or liver as "diagnosed by ultrasound" by Vet 1 earlier.
Gender. Females of all breeds, even when spayed, have a higher risk for AHA than males.
Genetic predispostion. Some dogs have changes in their immune system, a deficiency of pyruvate kinaese enzymes or abnormal red blood cell structure.
Breeds at higher risk. American Cocker Spaniels, Beagles, Old English Sheepdog, Westies, Shih Tzus, Alaskan Malamute, Lhasa Apso, Poodles, Basenjis, Daschunds. The case being reviewed is a Miniature Schnauzer, female, spayed.
TWO BLOOD TESTS WITHIN 24 HOURS.
Low red cell counts, low haemoglobin and lower platelet count.
In theory, the haemoglobin should be high if there is AHA. This is because the destroyed red cells will lead to an increase in haemoglobin and not to a decrease.
However total white cells were in the normal range. I noted that the % of neutrophils was over 90% (normal dog is usually around 75%). The dog responded to baytril IV, metronidazole IV, Vit K1 IV and dexamethasone 0.2 ml IV, iron SC and Vit B complex SC on day 1 as the gums became pink 24 hours later.
TREATMENT
1. Most dogs with AHA respond to steroid therapy which may be required for years. Prednisolone suppresses the immune system to prevent red blood cell destruction. Bacterial, viral and fungal infections must be treated if present.
Oral prednisolone in high doses e.g. 2-4mg/kg q 24hr divided into 2X/day, starting at 2 mg and increasing dosage if response is poor. Give for 2- weeks, then gradually taper off dosage. Decrease to mg/kg/24 hours for 2-4 weeks, then 1 mg/kg/48 hours for 2-4 weeks, then taper off.
*If anaemia (one author in a dog's forum uses PCV as below 12% as unstable, PCV 35-55% as stable). If unstable, go back to previous dosage that works.
2. A gastroprotecant e.g. sucralfate (0.5-1g) given when the dog is on high doses of steroids.
3. IMMUNOSUPPRESSANT medications like cyclophosphamide together with lower dosage of steroids for severe AIHA, for several months and reassess 2-4 weekly. Most dogs respond to prednisolone and immunosuppressant. If there is a relapse, a longer course of medication may be required.
Cyclophosphamide (50mg/Ma p/o q 24 hr) or 2 mg/kg q 24hr for the first 4 days of each week for 6-8 weeks. Re-assess.
Azathioprine (50mg/Ma q 24hr) (2mg/kg p o q 24 hr) for 1-2 weeks, then every other day
Cyclosporin (15mg/kg po q 24hr) has been used to treat refractory AIHA.
Danazol (synthetic androgen, 5 mg/kg po q 12 hr). Expensive. Reserved for dogs that have are refractory to pred + cyclophosphamide or azathioprine or intolerant drug side effects. Contraindicated in dogs with heart, liver or kidney problems.
3. For severe cases, blood transfusions, splenectomy (last resort in life-threatening refractory anaemia if medical treatment is not controlling the disease after 4-6 weeks of therapy).) and intravenous immunoglubulin therapy. Blood transfusion may be needed in the very severe anaemic dog to buy time for the drugs to act.
http://www.kongyuensing.com/folder5/201006220very-low-platelet-count-Schnauzer-10years_anorexic-ToaPayohVets.htm
So far, the lady said that the dog's gums had become pinker. The dog is eating and drinking and passes normal stools and urine. Her only complaint was that the dog had this panting throughout the day during the past 2 weeks. She said: "She may be feeling some pain."
Well, the dog did have a very painful slipped disc when I first checked her. She also had a painful bladder area on palpation.
What is the cause of this panting? Is the old dog with white gums suffering from a form of an autoimmune haemolytic anaemia (AHA)? In AHA, the dog's red blood cells are produced normally but its abnormal antibodies which are needed to destroy bacteria or viruses, start destroying the red blood cells. So, the dog has low red blood cells and suffers from anemia.
In AHA, the dog also has low numbers of platelets and suffers from thrombocytopenia. The platelets in the blood form clots when blood vessels are cut or broken. If the dog has low platelet count, there will be uncontrolled bleeding. AHA in dogs is similar to haemopilia in people.
SYMPTOMS
Anaemia. Pale or white gums, conjunctiva and later yellow instead of normal pink to red colour. So the dog is lethargic as it has low levels of oxygen in the tissues and brain.
Jaundice. The liver removes the damaged red cells. The breakdown products causes a yellow colour of gums, conjunctiva and skin.
Bleeding from the nose or blood in the stools due to low platelet count. Takes a longer time for bleeding to stop.
Heart beats faster to bring oxygen to the tissues and brain.
DIAGNOSIS
1. COOMBS TEST is used to check for antiglobulins (autoantibodies). Nearly 98% of human patients with AIHA have a positive direct Coombs test (also known as direct antiglobulin test or DAT). A positive DAT means that the red blood cells are coated with the red blood cell autoantibodies. Patients may only have a positive direct Coombs test during disease flares and not at all times. There is also the Coombs Negative AIHA as a result of vaccinations or other medical conditions and the patient is mis-diagnosed as having other types of anemia or non-immune haemolytic anemia.
2. BONE MARROW BIOPSY
AIHA may be either regenerative or non-regenerative as determined by a lab examination of a blood sample and/or bone marrow biopsy. Regenerative anaemia - increased numbers of large immature red blood cells (reticuloycytes). Non-regenerative anaemia - anaemia lasting >5 days with low reticulocytes; the immature red cells are made but are destroyed in the bone marrow by the dog's own immune system.
As Vet 1's blood results did not include platelets (IDDEX machine had advised another blood test), so there was no earlier blood test history in relation to RBC, HB and platelets.
Dogs with chronic AIHA take many weeks to show clinical signs as in this case.
A bone marrow biopsy is used to distinguished between non-regenerative AIHA and cancer or other causes of non-regenerative haemolytic anaemia. But few vets do this bone marrow biopsy and diagnose the dog with chronic non-regenerative AIHA as suffering from blood cancer.
IN THE CASE OF THE DOG WITH WHITE GUMS, it was difficult to collect the urine for analysis of the presence of haemoglobin in the urine. The dog was in great pain and I stopped catherisation of the urethra for urine. She peed the normal yellow urine instead of the dark red urine in AHA.
CAUSES
Genetic or environmental factors. The latter include infections, drugs, poisons, bee stings and vaccines. Various neoplasms, systemic lupus erythematosus and canine hypothyroidism.
The dog had not been vaccinated for the past few years and so vaccination would not be the cause. The dog was recently taken outdoors after living in the apartment for most of her life. Infections could be the cause.
Some indications of infections include ulcers at the back of the tongue on the left side. (I took a picture 24 hours after IV treatment when I examined the tongue and tonsills). At the first consultation, the dog wanted to bite me when I palpated the enlarged left submandibular and popliteal lymph nodes.
Tumours. Since the dog had been losing weight of 25% for the past 4 weeks (from 5kg to 4kg), it could be suffering from internal tumours, e.g. in the spleen, pancreas or liver as "diagnosed by ultrasound" by Vet 1 earlier.
Gender. Females of all breeds, even when spayed, have a higher risk for AHA than males.
Genetic predispostion. Some dogs have changes in their immune system, a deficiency of pyruvate kinaese enzymes or abnormal red blood cell structure.
Breeds at higher risk. American Cocker Spaniels, Beagles, Old English Sheepdog, Westies, Shih Tzus, Alaskan Malamute, Lhasa Apso, Poodles, Basenjis, Daschunds. The case being reviewed is a Miniature Schnauzer, female, spayed.
TWO BLOOD TESTS WITHIN 24 HOURS.
Low red cell counts, low haemoglobin and lower platelet count.
In theory, the haemoglobin should be high if there is AHA. This is because the destroyed red cells will lead to an increase in haemoglobin and not to a decrease.
However total white cells were in the normal range. I noted that the % of neutrophils was over 90% (normal dog is usually around 75%). The dog responded to baytril IV, metronidazole IV, Vit K1 IV and dexamethasone 0.2 ml IV, iron SC and Vit B complex SC on day 1 as the gums became pink 24 hours later.
TREATMENT
1. Most dogs with AHA respond to steroid therapy which may be required for years. Prednisolone suppresses the immune system to prevent red blood cell destruction. Bacterial, viral and fungal infections must be treated if present.
Oral prednisolone in high doses e.g. 2-4mg/kg q 24hr divided into 2X/day, starting at 2 mg and increasing dosage if response is poor. Give for 2- weeks, then gradually taper off dosage. Decrease to mg/kg/24 hours for 2-4 weeks, then 1 mg/kg/48 hours for 2-4 weeks, then taper off.
*If anaemia (one author in a dog's forum uses PCV as below 12% as unstable, PCV 35-55% as stable). If unstable, go back to previous dosage that works.
2. A gastroprotecant e.g. sucralfate (0.5-1g) given when the dog is on high doses of steroids.
3. IMMUNOSUPPRESSANT medications like cyclophosphamide together with lower dosage of steroids for severe AIHA, for several months and reassess 2-4 weekly. Most dogs respond to prednisolone and immunosuppressant. If there is a relapse, a longer course of medication may be required.
Cyclophosphamide (50mg/Ma p/o q 24 hr) or 2 mg/kg q 24hr for the first 4 days of each week for 6-8 weeks. Re-assess.
Azathioprine (50mg/Ma q 24hr) (2mg/kg p o q 24 hr) for 1-2 weeks, then every other day
Cyclosporin (15mg/kg po q 24hr) has been used to treat refractory AIHA.
Danazol (synthetic androgen, 5 mg/kg po q 12 hr). Expensive. Reserved for dogs that have are refractory to pred + cyclophosphamide or azathioprine or intolerant drug side effects. Contraindicated in dogs with heart, liver or kidney problems.
3. For severe cases, blood transfusions, splenectomy (last resort in life-threatening refractory anaemia if medical treatment is not controlling the disease after 4-6 weeks of therapy).) and intravenous immunoglubulin therapy. Blood transfusion may be needed in the very severe anaemic dog to buy time for the drugs to act.
Wednesday, November 24, 2010
The Panting Old Schnauzer with low platelet count
It is almost two weeks since I saw the dog with the low platelet count. The case is recorded at:
http://www.kongyuensing.com/folder5/201006220very-low-platelet-count-Schnauzer-10years_anorexic-ToaPayohVets.htm
Yesterday I phoned the busy young lady as there was no news from her. No news means good news. The young lady said: "My dog has pinker gums. She is eating. I have given her the prednisolone half tablet two times per day. But she pants heavily the whole day. Could it be the pain? She may need an X-ray as you had advised. Or a blood test. Should I get her examined by you?"
It is hard to diagnose over the phone. I was glad that this dog had not died from internal bleeding due to such a low platelet count. I gave her an appointment to see her dog at 9.30 am on Thursday.
A follow-up in such a case is important but some owners may not have the time to do the follow up till the dog collapses.
http://www.kongyuensing.com/folder5/201006220very-low-platelet-count-Schnauzer-10years_anorexic-ToaPayohVets.htm
Yesterday I phoned the busy young lady as there was no news from her. No news means good news. The young lady said: "My dog has pinker gums. She is eating. I have given her the prednisolone half tablet two times per day. But she pants heavily the whole day. Could it be the pain? She may need an X-ray as you had advised. Or a blood test. Should I get her examined by you?"
It is hard to diagnose over the phone. I was glad that this dog had not died from internal bleeding due to such a low platelet count. I gave her an appointment to see her dog at 9.30 am on Thursday.
A follow-up in such a case is important but some owners may not have the time to do the follow up till the dog collapses.
253. Ticks in the apartment dog
Each dog owner has his or her own favourite vet and so I did not want to interfere in this case as this 70-year-old man may view me as soliciting for business. He is a general trader by profession and yesterday he invited me to his apartment to collect some multi-vitamins and calcium which he had bought at a discount from a China trade fair last week. "The company officers at the fair did not want to take the bottles back and sold them at huge discounts on the last day of the fair. If you don't want them, I will offer them to James. He will surely buy them."
I am personally not keen on taking multivitamins and calcium from unknown drug companies as there had been horror stories from one company in Australia producing poor quality multi-vitamins marketed by health shops in Singapore some years ago. There was no quality control but a desire to make money.
I accepted his invitation to visit him as a friend. He had two dogs. One 17-year-old cross had died recently and suddenly of a bloated stomach and he was still grieving over the loss.
"He killed the dog with too much vitamins and glucosamine," the wife told me.
"Based on the history of sudden swelling of the abdomen, I think the dog had a ruptured big blood vessel due to old age. The dog's abdomen started to swell as the bleeding filled the abdomen. The dog lives to a ripe old age of 17 years and it is inevitable that the big blood vessel would break down. The only way to find the definite cause of death is a post-mortem."
"No point in having a post-mortem," the husband said that the dog had been cremated.
"When I die, I have asked my children to scatter my ashes in the sea," the wife said. "That will save them the trouble of having them to maintain my grave or urn. The later generations may forget about doing any maintenance."
The husband shocked me by saying: "Your ashes in the sea will kill all the fishes!" What a surprising thing to say. This was the first time I met the wife, a silver-haired trim lady.
"Well," I said to the husband to defuse the awkwardness of his comments, "Your ashes in the sea will kill all the whales."
The wife kept picking out the ticks from her Silkie Terrier. "The ticks keep appearing on the dog. Small dotted ones."
"Did you use spot-on insecticides like Frontline?" I asked.
"Not effective."
So this 7-year-old Silkie had been biting her back area till they were almost bald. "This could be a tick-bite allergy," I said to the wife. The dog was on prednisolone tablets and anti-ringworm tablets for many weeks.
I had to intervene for the sake of this poor dog. "I cannot guarantee, but this dog may have a full coat of hair if you can get rid of the ticks in the apartment and on this dog."
"Really?" the wife was interested as to what she should do.
"I cannot guarantee anything," I said. "The first step is to get the dog clipped bald, de-ticked and given a different type of spot-on insecticide. De-contaminate the apartment area where the dog stays usually. Best of all, after de-ticking put the dog in another part of the apartment so that the baby ticks cannot jump onto her.
"Will the dog have a full coat during Christmas?"
"I cannot guarantee it. Do you have a good groomer who can clip the dog bald and de-ticked? Ask your vet for a different spot-on insecticide."
Ticks in a dog can be difficult to be rid of due to the re-infestation from the surroundings. Apparently this dog does not go outdoors and therefore the ticks must be from inside the apartment. "My vet advised Bagon spray onto the walls," the wife said. "It does not work."
"It is hard to get rid of ticks if you don't isolate the de-ticked dog from the contaminated area," I said. "In any case, there are so many cracks in the wall and you need to do it thoroughly. Some vets and pest control companies advise 'bombs'. You close all the windows. Release the gas from the bombs to fumigate and kill all the ticks. It does not work in practice for many reasons."
"You have two dogs. Get both of them clipped bald and de-ticked by your groomer or your vet."
Many owners have their preferred vets and so I just give some free advices.
I am personally not keen on taking multivitamins and calcium from unknown drug companies as there had been horror stories from one company in Australia producing poor quality multi-vitamins marketed by health shops in Singapore some years ago. There was no quality control but a desire to make money.
I accepted his invitation to visit him as a friend. He had two dogs. One 17-year-old cross had died recently and suddenly of a bloated stomach and he was still grieving over the loss.
"He killed the dog with too much vitamins and glucosamine," the wife told me.
"Based on the history of sudden swelling of the abdomen, I think the dog had a ruptured big blood vessel due to old age. The dog's abdomen started to swell as the bleeding filled the abdomen. The dog lives to a ripe old age of 17 years and it is inevitable that the big blood vessel would break down. The only way to find the definite cause of death is a post-mortem."
"No point in having a post-mortem," the husband said that the dog had been cremated.
"When I die, I have asked my children to scatter my ashes in the sea," the wife said. "That will save them the trouble of having them to maintain my grave or urn. The later generations may forget about doing any maintenance."
The husband shocked me by saying: "Your ashes in the sea will kill all the fishes!" What a surprising thing to say. This was the first time I met the wife, a silver-haired trim lady.
"Well," I said to the husband to defuse the awkwardness of his comments, "Your ashes in the sea will kill all the whales."
The wife kept picking out the ticks from her Silkie Terrier. "The ticks keep appearing on the dog. Small dotted ones."
"Did you use spot-on insecticides like Frontline?" I asked.
"Not effective."
So this 7-year-old Silkie had been biting her back area till they were almost bald. "This could be a tick-bite allergy," I said to the wife. The dog was on prednisolone tablets and anti-ringworm tablets for many weeks.
I had to intervene for the sake of this poor dog. "I cannot guarantee, but this dog may have a full coat of hair if you can get rid of the ticks in the apartment and on this dog."
"Really?" the wife was interested as to what she should do.
"I cannot guarantee anything," I said. "The first step is to get the dog clipped bald, de-ticked and given a different type of spot-on insecticide. De-contaminate the apartment area where the dog stays usually. Best of all, after de-ticking put the dog in another part of the apartment so that the baby ticks cannot jump onto her.
"Will the dog have a full coat during Christmas?"
"I cannot guarantee it. Do you have a good groomer who can clip the dog bald and de-ticked? Ask your vet for a different spot-on insecticide."
Ticks in a dog can be difficult to be rid of due to the re-infestation from the surroundings. Apparently this dog does not go outdoors and therefore the ticks must be from inside the apartment. "My vet advised Bagon spray onto the walls," the wife said. "It does not work."
"It is hard to get rid of ticks if you don't isolate the de-ticked dog from the contaminated area," I said. "In any case, there are so many cracks in the wall and you need to do it thoroughly. Some vets and pest control companies advise 'bombs'. You close all the windows. Release the gas from the bombs to fumigate and kill all the ticks. It does not work in practice for many reasons."
"You have two dogs. Get both of them clipped bald and de-ticked by your groomer or your vet."
Many owners have their preferred vets and so I just give some free advices.
252. The itchy 15-year-old & the 10-year old female dogs
CASE 1. RINGWORM AND POSSIBLY OPEN PYOMETRA
"Can you remember this dog?" the man in his late 20s put the Maltese X with fully formed cataracts in her eyes on the consultation table.
"No," I said. "It is not easy to identify Malteses or their crosses as they look almost alike."
"In June, you extracted her right tooth which you said was infected with pus," the man said as I referred to the medical records.
"Yes," I said. "This 15-year-old must be the oldest dog in Singapore to suffer from an oro-nasal fistula. How is she now?"
"No more problem," the man showed me the right side of the face. Hair had fully grown and as I tried to open the dog's mouth, she turned her head away. The owner tried but was not successful. The old dog remembered the pain and was avoiding the pain.
"What's her problem today?" I asked.
"She is itchy and keeps rubbing her back on the floor."
The dog's back was losing hair compared to the fullness of hair on the face.
I put some of the back hairs under the microscope. "There is ringworm in the hairs," I asked the young man to view the hairs.
"Does the dog lick her private parts?" I asked. "See the vulval area. It is swollen and is 10 times larger than normal."
"I don't think so. She only licks her thighs," he said.
"To you, it appears that the thighs are itchy as well." I said. "She has some infections, either in the womb as she is not spayed or in the bladder. As she is so old, I would not advise spaying. If spaying had been done at a young age, we could be sure that the dog would not be suffering from infections of the womb or have ovarian cysts or tumours."
Due to economic reasons, I did not advocate more tests. The owner wanted to clip the dog himself as he had bought a clipper. "It is not that easy for you to shave her completely bald," I said. "You can't even open her mouth for me to examine her teeth." I had not forced this old dog to open her mouth this time as her main problem was the skin. It would be prudent to check the mouth but then she had her dental work and scaling just 6 months ago and had no bad breath. So, I spared her the agony.
What's the cause of the skin itchiness? Although ringworm is a primary cause in the back skin, there may be a more serious problem. It is likely that this 15-year-old dog has open pyometra. She keeps leaking out pus from her vagina. She licks off the discharge to be clean. So the irritated vulval lips become swollen 10X over the past few days or weeks. To the owner, she is just having itchy thighs and back area.
TIPS: Spay your female dog when she is young. If she lives to 15 years, she will not be having pyometra.
Her oro-nasal fistula case is recorded at:
http://www.bekindtopets.com/dogs/20100615oro_nasal_fistula_carnaissal_tooth_abscess_old_dog_ToaPayohVets.htm
CASE 2.
"What are those bluish lumps?" the young lady asked me. "I check my dog daily and saw them last week." The soft lumps under the skin were present between MG4 and MG5 on the left side. MG = Mammary Gland (breasts).
"They are breast tumours," I said. "The lumps may be cancerous if they grow fast."
"What to do?"
"Surgery to remove them while they are small in size," I said. "If they are cancerous, they will spread to the other breasts or grow to big sizes like ping-pong balls.
As the lady was worried about anaesthesia, she chose to have a complete blood test done to check whether her dog was healthy. "Whether she is healthy or not," I said. "Your dog needs surgery if the breast tumours grow big and fast. It will be too late if you wait another few weeks."
TIPS
Early spay will usually not result in breast tumours in the female dog in the majority of cases.
"Can you remember this dog?" the man in his late 20s put the Maltese X with fully formed cataracts in her eyes on the consultation table.
"No," I said. "It is not easy to identify Malteses or their crosses as they look almost alike."
"In June, you extracted her right tooth which you said was infected with pus," the man said as I referred to the medical records.
"Yes," I said. "This 15-year-old must be the oldest dog in Singapore to suffer from an oro-nasal fistula. How is she now?"
"No more problem," the man showed me the right side of the face. Hair had fully grown and as I tried to open the dog's mouth, she turned her head away. The owner tried but was not successful. The old dog remembered the pain and was avoiding the pain.
"What's her problem today?" I asked.
"She is itchy and keeps rubbing her back on the floor."
The dog's back was losing hair compared to the fullness of hair on the face.
I put some of the back hairs under the microscope. "There is ringworm in the hairs," I asked the young man to view the hairs.
"Does the dog lick her private parts?" I asked. "See the vulval area. It is swollen and is 10 times larger than normal."
"I don't think so. She only licks her thighs," he said.
"To you, it appears that the thighs are itchy as well." I said. "She has some infections, either in the womb as she is not spayed or in the bladder. As she is so old, I would not advise spaying. If spaying had been done at a young age, we could be sure that the dog would not be suffering from infections of the womb or have ovarian cysts or tumours."
Due to economic reasons, I did not advocate more tests. The owner wanted to clip the dog himself as he had bought a clipper. "It is not that easy for you to shave her completely bald," I said. "You can't even open her mouth for me to examine her teeth." I had not forced this old dog to open her mouth this time as her main problem was the skin. It would be prudent to check the mouth but then she had her dental work and scaling just 6 months ago and had no bad breath. So, I spared her the agony.
What's the cause of the skin itchiness? Although ringworm is a primary cause in the back skin, there may be a more serious problem. It is likely that this 15-year-old dog has open pyometra. She keeps leaking out pus from her vagina. She licks off the discharge to be clean. So the irritated vulval lips become swollen 10X over the past few days or weeks. To the owner, she is just having itchy thighs and back area.
TIPS: Spay your female dog when she is young. If she lives to 15 years, she will not be having pyometra.
Her oro-nasal fistula case is recorded at:
http://www.bekindtopets.com/dogs/20100615oro_nasal_fistula_carnaissal_tooth_abscess_old_dog_ToaPayohVets.htm
CASE 2.
"What are those bluish lumps?" the young lady asked me. "I check my dog daily and saw them last week." The soft lumps under the skin were present between MG4 and MG5 on the left side. MG = Mammary Gland (breasts).
"They are breast tumours," I said. "The lumps may be cancerous if they grow fast."
"What to do?"
"Surgery to remove them while they are small in size," I said. "If they are cancerous, they will spread to the other breasts or grow to big sizes like ping-pong balls.
As the lady was worried about anaesthesia, she chose to have a complete blood test done to check whether her dog was healthy. "Whether she is healthy or not," I said. "Your dog needs surgery if the breast tumours grow big and fast. It will be too late if you wait another few weeks."
TIPS
Early spay will usually not result in breast tumours in the female dog in the majority of cases.
Tuesday, November 23, 2010
252. Misperceptions
"You must have a rich father to be able to study veterinary medicine in Scotland?" the project officer of similar age to mine, said. 30 years ago, one British pound was 8 Singapore dollars and those who studied overseas were from wealthy families.
"No," I said. "I was fortunate that the British Government gave the Colombo Plan Scholarship to enable me to study veterinary medicine in Glasgow University, Scotland. Now, Singapore has become a developed country and is in a position to offer ASEAN scholarships to students so that they can go home to help their country people."
I met him and his boss (a younger man in the family business) yesterday Nov 22, 2010 as my friend Khin Khin, asked me to be present to help her in her discussions about export Myanmar sand to Singapore. The Singapore English, thinking and culture of business is clearer to me than to her and so I was useful to her. The JTC would be tendering to buy sand on Dec 3, 2010 and Khin Khin was anxious to close a deal as an agent. If successful in getting 5 million cubic tonnes of sand for 18 months, she could get a commission of some $200,000/cubic tonne or some large figures. It sure beats spaying a dog for $200.00 as I will need to spay every dog in Singapore, probably.
Personally, I am not interested in this wheeling and dealing as it waste a lot of time. But I do attend some of Khin Khin's meetings and I do meet interesting characters for my stories. At the meeting, I will write notes for Khin Khin as she listens and learns the tricks of the commodity agency trade. For the past two years, she has not closed a deal. Well, I better stick to veterinary medicine.
After the meeting, the project officer invited us to have some coffee. Khin Khin had to go and I stayed behind to socialise with him and his boss. This boss is a young man and I said: "You must be driving a Lamborghini or a Ferrari," I had the impression that he was the type who would be doing it since his business must be successful. Supplying sand to the JTC is big business and if he can think of doing it, he must have the financial backup as there are financial performance bonds and penalties. He said that the freight cost of importing the sand from Myanmar to Singapore would cost more than the sales price of sand, which if rejected by the JTC would cost him a lot of money. That meant that he has the sufficient funds to undertake this venture.
"No, no," the young man said. "I drive a BMW."
The project officer said: "He would be buying a Lamborghini soon."
I was impressed.
"Well, I put in a bid when the LTA auctions the car," the young man said. "The LTA (Land Transport Authority) caught its senior manager milking it millions of dollars and is trying to recover some monies back by selling this senior manager's Lamborghini soon."
As a car depreciates in value, the LTA can't wait till the end of the court case to sell this car. This young man may be lucky to get a Lamborghini at below market price!
"No," I said. "I was fortunate that the British Government gave the Colombo Plan Scholarship to enable me to study veterinary medicine in Glasgow University, Scotland. Now, Singapore has become a developed country and is in a position to offer ASEAN scholarships to students so that they can go home to help their country people."
I met him and his boss (a younger man in the family business) yesterday Nov 22, 2010 as my friend Khin Khin, asked me to be present to help her in her discussions about export Myanmar sand to Singapore. The Singapore English, thinking and culture of business is clearer to me than to her and so I was useful to her. The JTC would be tendering to buy sand on Dec 3, 2010 and Khin Khin was anxious to close a deal as an agent. If successful in getting 5 million cubic tonnes of sand for 18 months, she could get a commission of some $200,000/cubic tonne or some large figures. It sure beats spaying a dog for $200.00 as I will need to spay every dog in Singapore, probably.
Personally, I am not interested in this wheeling and dealing as it waste a lot of time. But I do attend some of Khin Khin's meetings and I do meet interesting characters for my stories. At the meeting, I will write notes for Khin Khin as she listens and learns the tricks of the commodity agency trade. For the past two years, she has not closed a deal. Well, I better stick to veterinary medicine.
After the meeting, the project officer invited us to have some coffee. Khin Khin had to go and I stayed behind to socialise with him and his boss. This boss is a young man and I said: "You must be driving a Lamborghini or a Ferrari," I had the impression that he was the type who would be doing it since his business must be successful. Supplying sand to the JTC is big business and if he can think of doing it, he must have the financial backup as there are financial performance bonds and penalties. He said that the freight cost of importing the sand from Myanmar to Singapore would cost more than the sales price of sand, which if rejected by the JTC would cost him a lot of money. That meant that he has the sufficient funds to undertake this venture.
"No, no," the young man said. "I drive a BMW."
The project officer said: "He would be buying a Lamborghini soon."
I was impressed.
"Well, I put in a bid when the LTA auctions the car," the young man said. "The LTA (Land Transport Authority) caught its senior manager milking it millions of dollars and is trying to recover some monies back by selling this senior manager's Lamborghini soon."
As a car depreciates in value, the LTA can't wait till the end of the court case to sell this car. This young man may be lucky to get a Lamborghini at below market price!
Subscribe to:
Posts (Atom)