Geocities webpages are no more. The following detailed website of cat mouth ulcers was previously published by a cat owner. After Geocities closed down, the webpage was gone. I managed to track it down to an archive and publish here for references
Wayback Machine
Jan Feb JUN
Previous capture 29 Next capture
1999 2000 2001
69 captures
29 Feb 00 - 28 Oct 09
sparklines
Close Help
Boot's Story:
Lymphocytic-Plasmacytic Stomatitis.
Feline Viruses, Auto Immune Diseases
& Interferon
"You Are The Wind Beneath My Wings"
from the movie Beaches
Sept 1996. Boots, shortly after he came home with us. Weighing about 7 lbs, and waiting for his boiled chicken.
Lymphocytic plasmacytic stomatitis (LPS) is thought to be an auto immune disease of the gums and lining of the mouth and throat, although the exact cause is unknown. It can only be confirmed through biopsy. Although the symptoms may appear the same, do not mistake this disease with chronic gingivitis which is almost always due to tartar buildup.
The first thing to understand about this condition is that this disease is generally a secondary symptom of a greater underlying viral infection such as Feline Immunodeficiency Virus, Feline Leukemia, Feline Herpes (aka Rhinotracheitis) or Calicivirus. Always, always have your kitty tested for FeLV and FIV if faced with this condition. Fortunately Boots tested negative, both at the shelter, and by our own veterinarian, however our vet did conclude that Boots was chronically infected with Feline Herpes.
These viruses may cause other symptoms besides the stomatitis. You may notice your cat is more susceptible to upper respiratory infections and eye problems. As this condition is also thought to be associated with auto immune deficiency, you are also dealing with a disease that is triggered by stress. The stress of being in a shelter for two years had eroded Boots' mouth and gums to the point where he couldn't swallow. He weighed seven pounds when we brought him home in August of 1996.
The single biggest thing we have found to make a difference in the management of this disease is Interferon, an anti-viral medication developed for use in humans. We now have three years experience with it, and we have seen a dramatic dramatic improvement with Boots.
Boots' stomatitis was very severe with involvement down the throat and into the larynx and the loss of 3 teeth, but we have managed to stabilize it to the point where he's now eating boiled chicken (spoiled cat) and has almost doubled his weight since we began this protocol.
Our initial routine with him was teeth and gum cleaning and cortisone if necessary every 3 months, Antirobe (Clindamycin) antibiotic 1 cc X2 daily, and 1 cc of diluted (30 units per 1 cc of sterile water) Interferon a day. Cortisone (Depo-Medrol) is also common therapy for this disease. But you want to try to minimize the amount you have to give as it has long term side effects. Used judiciously it helps to control the inflammation and pain. Some cats require cortisone on a monthly basis, however we have found that the Interferon has significantly reduced the progress of the disease, therefore we are giving it less often. Our doctor mixes the Interferon in the correct diluted dosage and freezes it in 10 cc syringes. Interferon has a very short shelf life and cannot be kept in the refridgerator over an extended period of time. We thaw one syringe and use it for 10 days. It is given orally, and is mostly water, so there's no taste. You can either syringe it directly into the mouth or mix it into food.
Regular teeth cleaning is necessary to control tartar buildup which can make the mouth and gum ulcers worse and also open the body up to serious infection, so its important that you monitor this closely.
Interferon is a drug that was originally developed for human cancer intervention, and is also being used in human AIDS treatment. It is the only known anti-viral medication mankind has developed. It has mixed success in humans, but veterinarians are having greater success with cats. Consequently it is being used to treat or manage many feline viral infections including calcivirus, herpes (both of which have stomatitis as a complication), Feline Leukemia, Feline Immunodeficiency Virus and even Feline Infectious Peritonitis.
If all else fails, removal of all the back teeth seems to provide relief. While this might seem extreme, cats can do very, very well without teeth as long as you feed them canned food, and the quality of their lives can be excellant.
I was reluctant to take home a sick cat, so soon after having lost my beautiful Tardy. But Boots caught my eye, and I know without a doubt it was Tardy who had pointed him in my direction. Boots was so pathetic looking, scrawny and haggard. I knew the wonderful volunteers at the shelter were doing everything they could to help him, but I also knew Boots was slowly failing, and that he would be hard to place. I couldn't leave him there, even though I thought at the time I was opening my heart to eventual grief. The shelter had been very, very careful to be sure I understood this was a lifetime problem. I took him on a foster basis, not yet ready to deal with what I thought was a terminal illness which would lead me to more grief. But after the first few hours of having him in a real home and watching him bound delightedly from empty room to empty room, I knew Boots was home, and I called to say he wasn't leaving. The shelter waved the adoption fee.
Not knowing anything about stomatitis, I had no idea how much could be done to manage this disease. Two years later Boots now weighs over 14 lbs. He purrs now, and he plays with the other cats. He rules the house. I know that God and my rainbow Tardy are watching over us, but I also know the real difference in these animal's lives has been the experience and the unbelievable knowledge of our vet. It has been the deciding factor in our ability to maintain their health.
If, for any reason you feel that your vet isn't dealing with this properly, I urge you to seek a second opinion. The key to our success lay in the fact that our doctor keeps up with current trends, and with the published literature, and we are the beneficiaries of his dedication to his profession.
I leave you with one final thought. Don't lose hope! Boots has taught me that although you might face the pain of losing an animal, it is always worth the risk to open up your heart, to love and to try. The reward is indescribable. I often wake up in the middle of the night to find Boots nuzzled against my face, purring.
Below you will find a number of links I have collected regarding Stomatitis, Viral diseases for which stomatitis is an opportunitistic symptom, and some info on Interferon. If you have any more questions, or comments never hesitate to e-mail me.
Boots today, at 15 lbs, healthy and happy.
Postscript: I have always believed that Tardy led us to Boots. On June 4, 1997 I finally trapped and took in a stray that had been visiting us for several weeks. The first thing our doctor did was look at his mouth. We now have two cats with this disease, and two cats who are thriving because of our vet's skill and Interferon. Sammy lives indoors with us now, and Tardy watches over us still.
September, 1999 Update: Boots continues to thrive. He is still on 30 units of Interferon daily and has been since August, 1996. Just recently I received an unexpected e-mail from the wonderful woman who worked with us on adopting Boots. One of her shelter co-workers had found Boots' Story on the web and printed out the information to help with one of their shelter cats. Jo sent me an e-mail asking if this was possibly the same Boots. We traded e-mails, and finally Jo came to visit us. I was so proud to show her how well he is doing, and we both shed a few tears of happiness. Life takes unexpected turns, and it is so fulfilling to have a circle completed.
November, 1999 Update: Sammy has developed a Herpes eye infection. We are treating it with two human Herpes medications - Viroptic and Chloroptic eyedrops 4 times a day, and 250 mgms of L-lysine amino acid twice a day. The Viroptic drops seem to sting, so I give him the Chloroptic drops first to water down the Viroptic side effect. This seems to work. After 4 weeks, the medication is having a noticeable effect. There is no more squinting and Sammy seems to have regained all his old habits and appears to feel no more discomfort.
February 28, 2000: Our vet has just returned from a conference and is hearing wonderful things about L-lysine and viral infections. I have continued Sammy on 250 mgms of L-lysine twice a day since his Herpes eye infection, even though that has resolved. I am convinced it is helping him stave off URI's when we take vet trips. Today our vet recommended we begin Boots on the same dosage.
Stomatitis Links
About Stomatitis:
Feline Stomatitis - site includes good photos of what this condition looks like.
Oral Ulcerations - Includes diagnostic procedures and drugs of choice for treatment
Feline Stomatitis - More on Stomatitis from Dental Vet
Mouth Problems in the Cat - from the Feline Advisory Board in the UK
Stomatitis - From the Cat Fancier's Association
Veterinary Dental Care & Problems of the Mouth
Understanding Your Pet's Immune System - a good basic explanation of how the immune system works. Warning! Its a little technical!!
About Herpes and Calici Viruses:
Feline Herpes Virus - A veterinarian's explanation.
Herpes Virus, Stomatitis and Interferon - Dr. Mike Richards continues with an explanation of treatment
Herpes Virus: Symptoms and Treatment - Another good explanation of the relationship between Herpes and stomatitis.
Use of Interferon in Feline Herpetic Keratitis - corneal ulcers are another complication of Herpes virus
Calici Virus, Upper Respiratory Infections & Mouth Ulcers - Not so common a virus, but complications can include stomatitis. Excellent info on dealing with Chronic Repiratory problems!
Chronic Nasal Disease - Causes and Treatment
Upper Respiratory Infections - What to do when Kitty has a cold
Cat Colds - Causes and Treatment
About Interferon and its use in treating other viruses:
Interferon and FeLV / FIV - Using Interferon to combat leukemia & immunodeficiency viruses.
Newer Methods for Treating FeLV - Includes a link to an company manufacturing Interferon, and protocols for use.
Smudge's Story - Smudge has Feline Leukemia, and he is truly an Interferon success story.
Chloe's Story - An excellent site for info on FeLV, including Interferon treatment.
Dr. Mike Richards - using Interferon for FeLV
Dr. Richard C. Weiss - developer of the FeLV vaccine. A list of published articles on the use of Interferon in treating FeLV
Colorado State University - Study on the use of Interferon in treating FeLV
Living with the FeLV+ or FIV+ Cat. - How viruses affect the cat, False Positives, Treatment, Information and Support. See the treatment section.
Pyewacket's Story - FIV and Interferon. A genuine success story.
Felix's Story: FIV and Interferon
FIP and Interferon - The use of Interferon in managing Feline Infectious Peritonitis
What is Interferon? - This site is for Human Hepatitis, but does a good job of explaining how Interferon works.
Interferon:Patent claims
Resources:
Dr. Camuti Memorial Feline Consultation & Diagnostic Service - a wonderful resource for either you or your vet. For a $35 consultation fee you can talk to a vet at Cornell about diagnosis, treatment and the protocols involving Interferon.
Saturday, May 7, 2011
Friday, May 6, 2011
431. GPs can't compete with subsidized health care at polyclinics in Singapore
SOME INTERESTING OBSERVATIONS AND COMPARISONS
Vets are equivalent to General Practitioners (GPs) in Singapore as both have first degrees. However, the Singapore GP have to compete with the subsidized health care at Polyclinics.
Some facts and figures from The Straits Times, April 25, 2011 - Let GPs handle the poor and polyclinics the elderly.
1. There are 1,600 GP clinics compared to over 45 veterinary clinics in 2011.
2. The PCPS is introduced by the Ministry of Health (MOH) 10 years ago for elderly patients to see a GP in a private clinic but pay subsidized polyclinic rates. The GPs get paid by the MOH.
Vets - More than 10 years ago, the Animal Infirmary at Kampong Java Road provides subsidized veterinary treatments to dog and cat owners. Subsidized in the sense that the cost of rental of the premises at Kampong Java were not included in the expenses of accounting. However, this is history. There were 2 or 3 private vet clinics as competitors.
There is a spay subsidized scheme for stray dogs and cats to be sterilised at private clinic. The vets get paid by the SPCA.
3. 200/1,600 GP clinics participate in the Primary Care Partnership Scheme (PCPS). Vets - those clinics participating are paid by the SPCA.
4. The PCPS is restricted to the elderly, the disabled and with low incomes. Those incomes at the bottom 30% of families, i.e.. a per capita income of $800 a month. Eligible are the disabled, unable to work due to old age, illness or disabled and those receiving Public Assistance.
Vets - no such scheme in Singapore although UK has the PDSA scheme similar to the PCPS. The PDSA does not restrict the scheme to only the low income group of the elderly and the disabled.
5. Consequently, more than 50% of the GPs provide aesthetic treatment to booster their income instead of focusing on practising mainstream medicine.
Vets - cosmetic surgeries are almost non-existent.
6. Polyclinic workload increase significantly in the past decade. In 2000, 18 polyclinics had 2.7 million consultations. In 2010, 4.3 million i.e.. 60% jump due to increased number of elderly people with chronic illnesses (high blood pressure, high cholesterol and diabetes).
7. Now the polyclinics try to assign repeat patients to the same doctor and to cut down waiting time. That means more consultations, taking patients away from the GPs.
Vets - no subsidized vet health care from the government.
8. Polyclinics doctors have o follow a set of treatment guidelines given by the specialists. E.g. diabetic patients must have blood tests, feet screened and eyes checked regularly. Well equipped with staff and equipment to do it. Polyclinics become centres of excellence for treating chronic diseases.
9. Rapidly aging population. One in 5 will be aged 65 years and older by 2030. So, polyclinics will have more patients, treating the poor and the chronically ill since healthcare is subsidized. Therefore GPs will likely get fewer patients. With high rentals as there are not many commercial properties being built, I don't know how GPs can survive in the next decade.
Vets - those renting are at the great mercy of landlords due to scarcity of commercial properties. No choice but to pay whatever amount the landlord wants. I think the new vet clinics will be able to survive as Singaporeans are time-pressed and prefer to go to a vet nearby. So, there is great hope for new vets who also charge lower fees. Unfortunately, it may not be economically feasible to go for low pricing and low workload to open a vet clinic. In 2011, it is believed that there are 600 pet shops are having difficulties surviving. Some 5 years ago, there were 200 pet shops and half close per year, according to one salesman.
Perhaps, it is better to be a commercial property landlord than to be a GP or vet if the person has no interest in practising.
There are some trends for GPs that need to be researched if the GP wants to sustain his business in the near future. The Animal Infirmary and its proposed privatisation are history now. It is unlikely that there will be a PDSA or equivalent PCPS concept as the government's priority is in food health and hygiene.
For the older vets, under-pricing by new vets is not an issue confined only to the veterinary business. The internet empowers pet owners and some know more than the vets as the pet owners focus on one issue discussed at forums and do order products from the internet freely and from pet shops to treat their pets or ask the pet shop operator to do the treatment.
Older vets may need to review their operations by knowing the trend. Do one or more of the following in the marketing grid. Provide new services, develop new products, increase market share by improving existing services/product range or diversify into other fields?
Personalised and excellent customer service are now more important. The same vet assigned to provide a continuity of treatment is what the sophisticated Singapore pet owner nowadays. Branding may also be more important now. In the final analysis, a good clinical or surgical outcome breeds referrals. Performance still counts as in all professions and for the vets, that means accurate diagnoses and knowing what to do in the treatment at affordable competitive costs. Merely being the cheapest vet in Singapore seeking high turnover may not be sustainable for the clinic business in the near term.
Vets are equivalent to General Practitioners (GPs) in Singapore as both have first degrees. However, the Singapore GP have to compete with the subsidized health care at Polyclinics.
Some facts and figures from The Straits Times, April 25, 2011 - Let GPs handle the poor and polyclinics the elderly.
1. There are 1,600 GP clinics compared to over 45 veterinary clinics in 2011.
2. The PCPS is introduced by the Ministry of Health (MOH) 10 years ago for elderly patients to see a GP in a private clinic but pay subsidized polyclinic rates. The GPs get paid by the MOH.
Vets - More than 10 years ago, the Animal Infirmary at Kampong Java Road provides subsidized veterinary treatments to dog and cat owners. Subsidized in the sense that the cost of rental of the premises at Kampong Java were not included in the expenses of accounting. However, this is history. There were 2 or 3 private vet clinics as competitors.
There is a spay subsidized scheme for stray dogs and cats to be sterilised at private clinic. The vets get paid by the SPCA.
3. 200/1,600 GP clinics participate in the Primary Care Partnership Scheme (PCPS). Vets - those clinics participating are paid by the SPCA.
4. The PCPS is restricted to the elderly, the disabled and with low incomes. Those incomes at the bottom 30% of families, i.e.. a per capita income of $800 a month. Eligible are the disabled, unable to work due to old age, illness or disabled and those receiving Public Assistance.
Vets - no such scheme in Singapore although UK has the PDSA scheme similar to the PCPS. The PDSA does not restrict the scheme to only the low income group of the elderly and the disabled.
5. Consequently, more than 50% of the GPs provide aesthetic treatment to booster their income instead of focusing on practising mainstream medicine.
Vets - cosmetic surgeries are almost non-existent.
6. Polyclinic workload increase significantly in the past decade. In 2000, 18 polyclinics had 2.7 million consultations. In 2010, 4.3 million i.e.. 60% jump due to increased number of elderly people with chronic illnesses (high blood pressure, high cholesterol and diabetes).
7. Now the polyclinics try to assign repeat patients to the same doctor and to cut down waiting time. That means more consultations, taking patients away from the GPs.
Vets - no subsidized vet health care from the government.
8. Polyclinics doctors have o follow a set of treatment guidelines given by the specialists. E.g. diabetic patients must have blood tests, feet screened and eyes checked regularly. Well equipped with staff and equipment to do it. Polyclinics become centres of excellence for treating chronic diseases.
9. Rapidly aging population. One in 5 will be aged 65 years and older by 2030. So, polyclinics will have more patients, treating the poor and the chronically ill since healthcare is subsidized. Therefore GPs will likely get fewer patients. With high rentals as there are not many commercial properties being built, I don't know how GPs can survive in the next decade.
Vets - those renting are at the great mercy of landlords due to scarcity of commercial properties. No choice but to pay whatever amount the landlord wants. I think the new vet clinics will be able to survive as Singaporeans are time-pressed and prefer to go to a vet nearby. So, there is great hope for new vets who also charge lower fees. Unfortunately, it may not be economically feasible to go for low pricing and low workload to open a vet clinic. In 2011, it is believed that there are 600 pet shops are having difficulties surviving. Some 5 years ago, there were 200 pet shops and half close per year, according to one salesman.
Perhaps, it is better to be a commercial property landlord than to be a GP or vet if the person has no interest in practising.
There are some trends for GPs that need to be researched if the GP wants to sustain his business in the near future. The Animal Infirmary and its proposed privatisation are history now. It is unlikely that there will be a PDSA or equivalent PCPS concept as the government's priority is in food health and hygiene.
For the older vets, under-pricing by new vets is not an issue confined only to the veterinary business. The internet empowers pet owners and some know more than the vets as the pet owners focus on one issue discussed at forums and do order products from the internet freely and from pet shops to treat their pets or ask the pet shop operator to do the treatment.
Older vets may need to review their operations by knowing the trend. Do one or more of the following in the marketing grid. Provide new services, develop new products, increase market share by improving existing services/product range or diversify into other fields?
Personalised and excellent customer service are now more important. The same vet assigned to provide a continuity of treatment is what the sophisticated Singapore pet owner nowadays. Branding may also be more important now. In the final analysis, a good clinical or surgical outcome breeds referrals. Performance still counts as in all professions and for the vets, that means accurate diagnoses and knowing what to do in the treatment at affordable competitive costs. Merely being the cheapest vet in Singapore seeking high turnover may not be sustainable for the clinic business in the near term.
Thursday, May 5, 2011
430. REA Examination - Net Present Value etc.
It is difficult for the lecturer to explain Net Present Value in real estate investment, part of the REA examination syllabus.
I got some info from ROI For Nonprofits by Tom Ralser
Chapter 8. Suggested Methodologies For Developing nonprofit ROI scenarios. The result allows the value of the outcome to be shown.
PRESENT VALUE BASICS
Situations can present value of future benefits e.g. enhanced earning potential for high school graduates or changed to present value of the costs avoided eg. disease prevention value. They involve the time value of money, a discoutn rate that reflects the risk and cost of funds and a series of cash flows.
CASH FLOWS
are periodic (usually annual) outlays required to get the nonprofit project underway and inflows (benefits) expected over the life of the project.
e.g. Cost at time zero = $100,000
Cash flow at time zero = -$100,000
DISCOUNt RATES
are like interest rates in reverse. The cash flows need to be brought back to the present day at a discount rate, with the present value being smaller. In present value terms, an apples-to-apples comparison can be made. The actual cost of money used for the project is also included.
NET PRESENT VALUE
Present value becomes net present value when the initial cost is included which is usually a negative flow. The basic formula is:
NPV = Sum (n)/t=0 CF1/(1+k)power of 1
where CDF=cash flow at period t and k is the cost of capital or the cost of money for the organisation.
In English, Net Present Value (NPV) is the sum of all of the periodic cash flows brought back to today at the appropriate discount rate.
Can anyone understand this?
CASH FLOWS
DISCOUNT RATES
This reflects the cost of capital for the organisation if gthe result is positive.
I got some info from ROI For Nonprofits by Tom Ralser
Chapter 8. Suggested Methodologies For Developing nonprofit ROI scenarios. The result allows the value of the outcome to be shown.
PRESENT VALUE BASICS
Situations can present value of future benefits e.g. enhanced earning potential for high school graduates or changed to present value of the costs avoided eg. disease prevention value. They involve the time value of money, a discoutn rate that reflects the risk and cost of funds and a series of cash flows.
CASH FLOWS
are periodic (usually annual) outlays required to get the nonprofit project underway and inflows (benefits) expected over the life of the project.
e.g. Cost at time zero = $100,000
Cash flow at time zero = -$100,000
DISCOUNt RATES
are like interest rates in reverse. The cash flows need to be brought back to the present day at a discount rate, with the present value being smaller. In present value terms, an apples-to-apples comparison can be made. The actual cost of money used for the project is also included.
NET PRESENT VALUE
Present value becomes net present value when the initial cost is included which is usually a negative flow. The basic formula is:
NPV = Sum (n)/t=0 CF1/(1+k)power of 1
where CDF=cash flow at period t and k is the cost of capital or the cost of money for the organisation.
In English, Net Present Value (NPV) is the sum of all of the periodic cash flows brought back to today at the appropriate discount rate.
Can anyone understand this?
CASH FLOWS
DISCOUNT RATES
This reflects the cost of capital for the organisation if gthe result is positive.
429. The pet transport man was frustrated
Yesterday I apologised to the pet transport man for scolding him. 2 days ago, I came back from my REA lectures and saw him clipping a cat in the operating room. The cat was anaesthesized with isoflurane gas via a mask. I was furious as I don't permit such procedures to be held at any time in the operating room and through all my 30 years of vet practice, I have always got the dirty part outside the operating room.
"It is not your fault that your cat was not sedated sufficiently for clipping," I said. "It will be a veterinary surgeon's fault. Now, a very clean operating room is necessary in any vet practice. Aseptic techniques in surgery may nothing to you as you are not a surgeon, but I am very fussy about making the operation room as clean as possible. By clipping the cat or dog inside, the room gets contaminated with hairs and dust and such matters will dirty the environment.
"That was why I was so surprised to see you clipping the cat's coat and so angry with you. So, I hope you will understand this."
The transport man had exchanged some angry words with me and said: "I don't have to come to your surgery (for my cases)." In reply I said: "Don't ever come again!"
The fault lies with the veterinarian. Xylazine 0.1 ml and Ketamine 0.8 ml IM just did not sedate a 8.5 kg cat. So the transport man had to drive back to Toa Payoh Vets to seek another sedation. Isoflurane gas was given by the vet and when I arrived, I saw the clipping just being started.
P.S.
Xylazine 0.2 and Ketamine 0.8 ml in one syringe IM would be excellent in my experience. Half the above dosage in cats less than 4 kg. As I had said, each vet has his or her own method of sedation. Some like just IV sedation. In my case, I prefer IM. The most important thing is not to let the customer feel frustrated for not having the outcome he desired. As veterinary medicine is learnt over the years, I did not comment much to the vet who had provided the service while the transport man suffered the brunt of my anger.
SOLVING THE TRANSPORT MAN'S PROBLEM.
After chasing the transport man out of the operating room, I had to bear the responsibility as to help him. He had come for sedation of this wild cat prior to clipping bald and the vet did provide him the service. It was unsatisfactory to him and now the baby was thrown out with the bath tub.
What I did was to get the cat clipped outside in a quiet room. The cat would be given isoflurane gas 5% by mask for around 1-3 minutes in the operating room. This was sufficient. A big barking dog in the animal holding area woke up the cat and therefore I got it into a quiet room to be clipped. There was no need to put it inside the operating room as isoflurane gas top up at 5% for 1-3 minutes is extremely effective in a sedated cat. Obviously, a better practice would be to give xylazine 0.2 ml + ketamine 0.8 ml in one syringe IM and the pet transport man would not be frustrated as he had to come back again.
"It is not your fault that your cat was not sedated sufficiently for clipping," I said. "It will be a veterinary surgeon's fault. Now, a very clean operating room is necessary in any vet practice. Aseptic techniques in surgery may nothing to you as you are not a surgeon, but I am very fussy about making the operation room as clean as possible. By clipping the cat or dog inside, the room gets contaminated with hairs and dust and such matters will dirty the environment.
"That was why I was so surprised to see you clipping the cat's coat and so angry with you. So, I hope you will understand this."
The transport man had exchanged some angry words with me and said: "I don't have to come to your surgery (for my cases)." In reply I said: "Don't ever come again!"
The fault lies with the veterinarian. Xylazine 0.1 ml and Ketamine 0.8 ml IM just did not sedate a 8.5 kg cat. So the transport man had to drive back to Toa Payoh Vets to seek another sedation. Isoflurane gas was given by the vet and when I arrived, I saw the clipping just being started.
P.S.
Xylazine 0.2 and Ketamine 0.8 ml in one syringe IM would be excellent in my experience. Half the above dosage in cats less than 4 kg. As I had said, each vet has his or her own method of sedation. Some like just IV sedation. In my case, I prefer IM. The most important thing is not to let the customer feel frustrated for not having the outcome he desired. As veterinary medicine is learnt over the years, I did not comment much to the vet who had provided the service while the transport man suffered the brunt of my anger.
SOLVING THE TRANSPORT MAN'S PROBLEM.
After chasing the transport man out of the operating room, I had to bear the responsibility as to help him. He had come for sedation of this wild cat prior to clipping bald and the vet did provide him the service. It was unsatisfactory to him and now the baby was thrown out with the bath tub.
What I did was to get the cat clipped outside in a quiet room. The cat would be given isoflurane gas 5% by mask for around 1-3 minutes in the operating room. This was sufficient. A big barking dog in the animal holding area woke up the cat and therefore I got it into a quiet room to be clipped. There was no need to put it inside the operating room as isoflurane gas top up at 5% for 1-3 minutes is extremely effective in a sedated cat. Obviously, a better practice would be to give xylazine 0.2 ml + ketamine 0.8 ml in one syringe IM and the pet transport man would not be frustrated as he had to come back again.
428. FLUTD - 3rd case. Incontinent and dysuria male cat
Things do come in 3s. This is the 3rd case within a short period of 7 days of a cat unable to pee normally. Dr Jason Teo saw the case at night on April 3, 2011. The owner called in the daytime to know about the progress as she was a student and worried about the veterinary costs. I do follow up during the day time as well as to teach my new assistant Mr Min in cat handling as he seemed to have a few cat scratches on his right hand. I did not ask how he got them yet but I know he has no experience handling cats.
"For the past 1 week, my cat could not urinate normally," the young lady said over the phone. "He dripped urine all over the apartment."
This is the 3rd case of FLUTD. Typical. Male, neutered, 5-year-old cat fed dry and canned food. A young cat inside the apartment sometimes fought with him but other than that, there was apparently no change in diet or environment. The owner did not want to pay for the urine and blood tests and so they were not done yesterday.
The owner needed to be educated that urine test must be taken to assess for the type and presence of urinary crystals (calcium oxalate as in my 2nd of 3 cases, none in my lst of 3 cases). Without urine testing, the vet just could not know recommend prevention programs effectively. Urine could be collected during catherisation as the cat was tranquilised, as part of the standard operating procedure for examination and to prevent misunderstandings from family members who might be misled that the vet was incompetent for not doing a urine test as expected of a reasonable vet in the same situation.
EXAMINATION 12-HOURS AFTER CATHERISATION LAST NIGHT
"The cat is fierce," Min said as the cat extended his claws when picked up for examination. I could see that this cat did not claw unless provoked further. I sedated him with the minimal dose 0.05 ml xylazine and 0.2 ml ketamine. He was quiet and isoflurane gas by mask anaesthesized him. I checked his bladder. It was empty and so I could not collect much urine. I could see red blood in the urine and he cat was slightly dehydrated. I gave him dextrose saline and antibiotics SC. The cat was given isoflurane for less than 5 minutes. After taking the gas off, the cat woke up fast and started to claw.
"Cover him with a big towel," I said to Min. A big towel must be ready for cats as it is hard to gripe an angry cat. This cat was the type who was not aggressive towards people. I saw that Min already had three fresh skin scratches on his hands and presumed he had got injured when holding some cats for my associate vets.
"Stroke the cat's chin," I taught Min to tickle the lower neck/jaw area. He felt strange and alien doing such an act. He had never heard of such soothing treatments. I presume that Yangon in Myanmar where he stayed does not have many cats. The cat quietened. I cut one of the two catheter' stitches while Min held the cat wrapped in a towel. Then we reversed roles so that he could gain some hands-on experience.
INITIATING CAUSE.
Unknown. There is another younger cat in the apartment. The urine and blood is being tested.
I phoned and discussed with Dr Teo the case to send the cat home to his familiar surroundings of food and litter box and to observe. The owner would be taking him home at night. She had given permission for blood and urine tests and these would be given to her the next day.
For all FLUTD cases, a urine test is advised. The young lady had a lot of questions as to what's happening. Without a urine test, it is very difficult to substantiate. Evidence-based medicine is good medicine. Follow ups will be done. Related themes happen in threes and since this is the 3rd FLUTD, I don't expect a 4th FLUTD soon.
P.S The other 2 recent cases are:
1. The hissing cat has difficulty peeing again
Initiating Cause - shift to new house recently.
Was treated by Vet 1 whose medical records did not indicate struvite. Cat was on Hills' S/D canned food for around 2 weeks as prescribed by Vet 1. No crystals found in the urine tested.
2 The cat cannot pee normally - 2 cases (the 2nd case in 2011)
Initiating Cause - humping by the other male cat for the past months is likely to traumatise this cat's penile area but the owner does not agree with this hypothesis. Calcium oxalate ++ present in the urine tested. This case shows that a urine test is very important for preventive measures.
For updates, goto www.toapayohvets.com, goto CATS --> Urinary Tract Problems
"For the past 1 week, my cat could not urinate normally," the young lady said over the phone. "He dripped urine all over the apartment."
This is the 3rd case of FLUTD. Typical. Male, neutered, 5-year-old cat fed dry and canned food. A young cat inside the apartment sometimes fought with him but other than that, there was apparently no change in diet or environment. The owner did not want to pay for the urine and blood tests and so they were not done yesterday.
The owner needed to be educated that urine test must be taken to assess for the type and presence of urinary crystals (calcium oxalate as in my 2nd of 3 cases, none in my lst of 3 cases). Without urine testing, the vet just could not know recommend prevention programs effectively. Urine could be collected during catherisation as the cat was tranquilised, as part of the standard operating procedure for examination and to prevent misunderstandings from family members who might be misled that the vet was incompetent for not doing a urine test as expected of a reasonable vet in the same situation.
EXAMINATION 12-HOURS AFTER CATHERISATION LAST NIGHT
"The cat is fierce," Min said as the cat extended his claws when picked up for examination. I could see that this cat did not claw unless provoked further. I sedated him with the minimal dose 0.05 ml xylazine and 0.2 ml ketamine. He was quiet and isoflurane gas by mask anaesthesized him. I checked his bladder. It was empty and so I could not collect much urine. I could see red blood in the urine and he cat was slightly dehydrated. I gave him dextrose saline and antibiotics SC. The cat was given isoflurane for less than 5 minutes. After taking the gas off, the cat woke up fast and started to claw.
"Cover him with a big towel," I said to Min. A big towel must be ready for cats as it is hard to gripe an angry cat. This cat was the type who was not aggressive towards people. I saw that Min already had three fresh skin scratches on his hands and presumed he had got injured when holding some cats for my associate vets.
"Stroke the cat's chin," I taught Min to tickle the lower neck/jaw area. He felt strange and alien doing such an act. He had never heard of such soothing treatments. I presume that Yangon in Myanmar where he stayed does not have many cats. The cat quietened. I cut one of the two catheter' stitches while Min held the cat wrapped in a towel. Then we reversed roles so that he could gain some hands-on experience.
INITIATING CAUSE.
Unknown. There is another younger cat in the apartment. The urine and blood is being tested.
I phoned and discussed with Dr Teo the case to send the cat home to his familiar surroundings of food and litter box and to observe. The owner would be taking him home at night. She had given permission for blood and urine tests and these would be given to her the next day.
For all FLUTD cases, a urine test is advised. The young lady had a lot of questions as to what's happening. Without a urine test, it is very difficult to substantiate. Evidence-based medicine is good medicine. Follow ups will be done. Related themes happen in threes and since this is the 3rd FLUTD, I don't expect a 4th FLUTD soon.
P.S The other 2 recent cases are:
1. The hissing cat has difficulty peeing again
Initiating Cause - shift to new house recently.
Was treated by Vet 1 whose medical records did not indicate struvite. Cat was on Hills' S/D canned food for around 2 weeks as prescribed by Vet 1. No crystals found in the urine tested.
2 The cat cannot pee normally - 2 cases (the 2nd case in 2011)
Initiating Cause - humping by the other male cat for the past months is likely to traumatise this cat's penile area but the owner does not agree with this hypothesis. Calcium oxalate ++ present in the urine tested. This case shows that a urine test is very important for preventive measures.
For updates, goto www.toapayohvets.com, goto CATS --> Urinary Tract Problems
Wednesday, May 4, 2011
The neutered male fights for his life
"He's an alpha," the cat lady said to me. "I adopted him from the SPCA. He is neutered as the SPCA does not release cats that are not sterilised. However, he goes around the neighbourhood fighting with other cats and at home, he is the boss of my other 2 cats.
"But he is a very protective and caring cat. When we had a puppy, he would prevent the other cats from going near the puppy! Once he saved my husband from a viper attack! That is why we all love him so much."
"Are there still vipers in Singapore, a concrete jungle?" I was surprised as one sees HDB flats and condos every where. They house almost 95% of the population.
"Yes, where we used to live. Cobras and pythons too. That is why we shifted out from the Seletar air base."
This white cat is 7 years old and he certainly has the size and standing to command respect from the neighbourhood cats. He did not come home one day and when he did, he just flopped on the floor and passed a lot of blood in the urine. T
"The grandmother thought he had died. He had no movement. He just lie on the floor. It was after midnight. We quickly phoned for the vet and got Dr Jason Teo to attend to the cat."
Now 4 days later, the cat looks bright but will not eat. The parents and a teenaged boy visited him daily. I explained the progress of the cat as I do day duty. "The figures for the white cell count, the blood urea and creatinine are doubled the upper end of the normal range," I showed the blood test report. It is likely that a type of bacteria had severely infected the cat's kidneys. Does he hunt rats and mice outdoors?"
The mother said: "He does catch geckos, but he does not eat them. I don't think there are rats and mice in our neighbourhood. Will he survive the kidney failure?"
"It is hard to say," I said. "A younger cat may have better chances of survival. He does not vomit but he also does not eat and he eats everything when he was normal." Dr Teo had advised them the prognosis and it was bad.
We will have to wait and see. The owner brought the cat's favourite canned food. The cat thumbed his nose at the food. He would rather drink. He is still being treated.
This case shows the importance of taking a blood test before treatment. The owner asked me: "Was the blood test taken before or after the treatment?" I showed her the date of the report which was the day the cat came in for emergency treatment. That satisfied her.
"But he is a very protective and caring cat. When we had a puppy, he would prevent the other cats from going near the puppy! Once he saved my husband from a viper attack! That is why we all love him so much."
"Are there still vipers in Singapore, a concrete jungle?" I was surprised as one sees HDB flats and condos every where. They house almost 95% of the population.
"Yes, where we used to live. Cobras and pythons too. That is why we shifted out from the Seletar air base."
This white cat is 7 years old and he certainly has the size and standing to command respect from the neighbourhood cats. He did not come home one day and when he did, he just flopped on the floor and passed a lot of blood in the urine. T
"The grandmother thought he had died. He had no movement. He just lie on the floor. It was after midnight. We quickly phoned for the vet and got Dr Jason Teo to attend to the cat."
Now 4 days later, the cat looks bright but will not eat. The parents and a teenaged boy visited him daily. I explained the progress of the cat as I do day duty. "The figures for the white cell count, the blood urea and creatinine are doubled the upper end of the normal range," I showed the blood test report. It is likely that a type of bacteria had severely infected the cat's kidneys. Does he hunt rats and mice outdoors?"
The mother said: "He does catch geckos, but he does not eat them. I don't think there are rats and mice in our neighbourhood. Will he survive the kidney failure?"
"It is hard to say," I said. "A younger cat may have better chances of survival. He does not vomit but he also does not eat and he eats everything when he was normal." Dr Teo had advised them the prognosis and it was bad.
We will have to wait and see. The owner brought the cat's favourite canned food. The cat thumbed his nose at the food. He would rather drink. He is still being treated.
This case shows the importance of taking a blood test before treatment. The owner asked me: "Was the blood test taken before or after the treatment?" I showed her the date of the report which was the day the cat came in for emergency treatment. That satisfied her.
426. Two cases of a cat having difficulty in peeing
NO NEWS IS GOOD NEWS
"The owner's previous male cat had the same problem of dysuria (difficulty in passing urine)," I said as I presented a 3-year-old male cat to the Senior Veterinarian, Dr Foo for radiography which is an X-ray of the bladder and kidneys. "He died a few weeks later."
Dr Foo frowned. He had performed at least a thousand cases in forty years of small animal practice and had a solid surgical reputation in my opinion. Deaths from urinary bladder obstruction would occur as no veterinarian could save every case and many owners had not complied with instructions to take medication, change to a calculolytic diet or go for a follow up. In most cases, the cat refused to take medication or accept a new diet and the owner could not do much.
I elaborated, "The owner did say that she had left the post-operative care of her first case to her mother as she was overseas. The cat would not take the medication and her mother had not consulted any veterinarian. The cat then died. Probably due to urinary bladder rupture and or kidney failure."
"No point taking X-rays," Dr Foo said. "Nothing will be seen as the cat with urolithiasis do not have solid stones."
"There may be obstruction by stones further up the bladder, in the ureter or in the kidneys," I said. "Although urethral obstruction in the cat is usually caused by an organic matrix which would not be seen clearly on X-rays, sometimes there may be crystals."
No urinary stones seen on X-rays
X-rays add to the veterinary costs and in the dog-eat-dog veterinary practices of Singapore, it was the least cost that attract the average pet owner. Overheads are high and if there are no clients, there will be no revenue and the practice will have to close within a year or two.
Dr Foo had been long in practice to understand that Singaporeans want cheap and good services. The competitor was nearby. Younger veterinarians in new practices underprice their services, a common situation in the private sector.
He was experienced but he could not command higher fees because the pet owners were not sophisticated enough yet to pay a premium for veterans. In fact, his fees were in some cases lower than the competition!
The mean age (50% of the cases) for urolithiasis in cats is 7 years old and the range 1 - 22 years old, but this cat was only 3 years old. He was a gentle slim cat with a "M" in his forehead, nervous about going outdoors and much loved by the equally trim and fit lady owner, a career lady who worked long hours into the night. She had said, "I hope you don't need to neuter him during treatment as I wanted him to be a father."
The cat was tranquilised and treated. It was difficult to dislodge the organic plug inside the urethra. After some five minutes, the urine shot out onto his hands.
The obstruction was cleared and the bladder was pressed to allow more urine to flow out. It was a relief as if we had urinary bladder obstruction. Nurse Ann's joy was short-lived. The urine flow stopped suddenly. The male cat urethra is very narrow and it was blocked again.
More work at dislodging the urethral plug. Dr Foo inserted a catheter into the urethra to let the urine flow out. Strong ammonia smell mixed with blood. Infected smelly urine. The urine had a strong ammonia smell as if it was kept for several days inside the bladder.
A neck collar was worn to prevent the cat from biting off the catheter which was sutured to the skin. Dr Foo said that the cat could go home with medication and that would mean least cost. But would that be in the interest of the cat? It was not easy for most Singapore owners to medicate a cat.
It would have been better to keep the cat for the next 3 days to observe and checked that his urinary obstruction and bleeding in the bladder had stopped. But the practice would be known as "expensive" and that would out price the competitors.
I had given him antibiotic and dextrose saline injections to flush out any "sand" inside his bladder. Two hours after surgery, he passed a large amount of smelly blood-stained urine. Seventeen hours later, his urine passed the smell test. It was not smelly and that was good.
Would his catheter get blocked? The owner brought the cat back the next day as I did not want her to incur more boarding costs.
The owner, being a doctor, would know what to do with medication and a change from dry cat feed to a low magnesium diet. The urine and the uroliths inside the urine were not sent for laboratory examination or bacterial culture because that would increase the cost of treatment.
In private practice all over the world, the average pet owner usually goes for the cheapest doctor.
Well, telephone consultations are free. I phoned the doctor five days later to enquire about this gentle cat. I left a message on her busy mobile phone for her to call me back. No call. I got her on her phone but she was busy at consultation.
"I can't talk now," she said.
"Is your cat OK?" I had to ask as this was the only chance since I did not expect her to return calls.
"Yes," she said and that was all. There were no return calls from her despite leaving messages on her mobile phone. Singaporeans seldom return phone calls unless they need to as they usually lead a hectic life.
It was best not to persist. No news is good news, that is the saying. I hope the cat had recovered well.
A Cat Can't Pee On Labour Day
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date: 04 May, 2011
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
The above-mentioned case, probably recorded in 2000, was fished out from my archives as I am keeping all my cat's urinary tract problem cases under
http://www.sinpets.com/cats/20110433cats-urinary-tract-urethra-obstruction-infections-toapayohvets-singapore.htm for ease of reviews and for clinical research.
On Sunday, May 1, 2011 (Labour Day in Singapore), I was manning the front desk while Dr Vanessa Lin was doing the consultation. A man in his early 50s phoned me as his cat could not urinate normally for the past two days. I had a discussion with Dr Vanessa Lin on the management of this case as I would be having the afternoon off as each vet handles a case of urethral obstruction differently. When the patient recovers, everybody is happy. But should the patient gets worse or dies, litigation and complaints may occur and I don't want that to happen to Toa Payoh Vets.
There are certain standard operating procedures I will want to advise the owner and be recorded in case of medical negligence litigation and I had to inform my associate vets as I was taking the afternoon off. These are:
1. urine collection for analysis of crystals, bacteria and blood - mandatory. Some vets do not do this and may be sued for possessing a lower standard of care if the cat dies since the vet has no defence of urine or blood tests.
2. blood collection for health screening is strongly advised esp. to check whether the kidney is affected and whether there is a severe bacterial infection. Fever may or may not be an indicative sign of this infection. If the owner does not want to pay for this test, this objection must be recorded in the case sheets.
3. As to whether the urinary catheter should stay in this cat for 2 days, I left that option to her. However, I said: "Usually I don't stitch the catheter after thoroughly irrigating the bladder if the urethra obstruction is a recent event as in this case".
For long-standing cases, I do stitch the catheter for 2 days and may irrigate the bladder again. See my procedures at: The hissing cat has difficulty peeing again
CAUSE OF THE URETHRAL OBSTRUCTION/URINARY TRACT INFECTION?
In this cat, there was no urethral obstruction as the catheter passed into the bladder easily. I spoke to the owner the next day as he came for the cat. Monday, May 2, 2011 was a public holiday as May 1 (Labour Day) happened on a Sunday.
What was the cause of this cat's dysuria problem?
"FLUTD (Feline Lower Urinary Tract Disease) usually occurs in a male neutered cat over 5 years of age," I was thinking that this cat could have some injury or infection.
"My cat is only one and a half years old and he is not neutered!" the IT man said to me.
"5-years is the average age," I said. "Some cases happen in younger cats. Is your cat busy mating with other cats and thereby suffering from traumatic injury?"
"Well, my other cat keeps humping him every month. But this has been going on for several months and there has been no problem with urination."
I try not to be antagonistic and impatient. I said: "Many events don't happen until they are performed often enough. For example, people don't get prawn allergies till they are eat prawns for many times. It is possible that your cat has traumatic injury to the penile area."
I don't want to appear soliciting for business by advising neutering of the humping cats and therefore let sleeping dogs lie. This cat's dysuria is likely to be a case of traumatic injury. The cat owner will give canned food instead of dry food. I will follow up on the cat's urine and blood test results.
TOA PAYOH VETS' URL
http://www.asiahomes.com/singaporetpvet/0707cat_urolithiasis.htm
"The owner's previous male cat had the same problem of dysuria (difficulty in passing urine)," I said as I presented a 3-year-old male cat to the Senior Veterinarian, Dr Foo for radiography which is an X-ray of the bladder and kidneys. "He died a few weeks later."
Dr Foo frowned. He had performed at least a thousand cases in forty years of small animal practice and had a solid surgical reputation in my opinion. Deaths from urinary bladder obstruction would occur as no veterinarian could save every case and many owners had not complied with instructions to take medication, change to a calculolytic diet or go for a follow up. In most cases, the cat refused to take medication or accept a new diet and the owner could not do much.
I elaborated, "The owner did say that she had left the post-operative care of her first case to her mother as she was overseas. The cat would not take the medication and her mother had not consulted any veterinarian. The cat then died. Probably due to urinary bladder rupture and or kidney failure."
"No point taking X-rays," Dr Foo said. "Nothing will be seen as the cat with urolithiasis do not have solid stones."
"There may be obstruction by stones further up the bladder, in the ureter or in the kidneys," I said. "Although urethral obstruction in the cat is usually caused by an organic matrix which would not be seen clearly on X-rays, sometimes there may be crystals."
No urinary stones seen on X-rays
X-rays add to the veterinary costs and in the dog-eat-dog veterinary practices of Singapore, it was the least cost that attract the average pet owner. Overheads are high and if there are no clients, there will be no revenue and the practice will have to close within a year or two.
Dr Foo had been long in practice to understand that Singaporeans want cheap and good services. The competitor was nearby. Younger veterinarians in new practices underprice their services, a common situation in the private sector.
He was experienced but he could not command higher fees because the pet owners were not sophisticated enough yet to pay a premium for veterans. In fact, his fees were in some cases lower than the competition!
The mean age (50% of the cases) for urolithiasis in cats is 7 years old and the range 1 - 22 years old, but this cat was only 3 years old. He was a gentle slim cat with a "M" in his forehead, nervous about going outdoors and much loved by the equally trim and fit lady owner, a career lady who worked long hours into the night. She had said, "I hope you don't need to neuter him during treatment as I wanted him to be a father."
The cat was tranquilised and treated. It was difficult to dislodge the organic plug inside the urethra. After some five minutes, the urine shot out onto his hands.
The obstruction was cleared and the bladder was pressed to allow more urine to flow out. It was a relief as if we had urinary bladder obstruction. Nurse Ann's joy was short-lived. The urine flow stopped suddenly. The male cat urethra is very narrow and it was blocked again.
More work at dislodging the urethral plug. Dr Foo inserted a catheter into the urethra to let the urine flow out. Strong ammonia smell mixed with blood. Infected smelly urine. The urine had a strong ammonia smell as if it was kept for several days inside the bladder.
A neck collar was worn to prevent the cat from biting off the catheter which was sutured to the skin. Dr Foo said that the cat could go home with medication and that would mean least cost. But would that be in the interest of the cat? It was not easy for most Singapore owners to medicate a cat.
It would have been better to keep the cat for the next 3 days to observe and checked that his urinary obstruction and bleeding in the bladder had stopped. But the practice would be known as "expensive" and that would out price the competitors.
I had given him antibiotic and dextrose saline injections to flush out any "sand" inside his bladder. Two hours after surgery, he passed a large amount of smelly blood-stained urine. Seventeen hours later, his urine passed the smell test. It was not smelly and that was good.
Would his catheter get blocked? The owner brought the cat back the next day as I did not want her to incur more boarding costs.
The owner, being a doctor, would know what to do with medication and a change from dry cat feed to a low magnesium diet. The urine and the uroliths inside the urine were not sent for laboratory examination or bacterial culture because that would increase the cost of treatment.
In private practice all over the world, the average pet owner usually goes for the cheapest doctor.
Well, telephone consultations are free. I phoned the doctor five days later to enquire about this gentle cat. I left a message on her busy mobile phone for her to call me back. No call. I got her on her phone but she was busy at consultation.
"I can't talk now," she said.
"Is your cat OK?" I had to ask as this was the only chance since I did not expect her to return calls.
"Yes," she said and that was all. There were no return calls from her despite leaving messages on her mobile phone. Singaporeans seldom return phone calls unless they need to as they usually lead a hectic life.
It was best not to persist. No news is good news, that is the saying. I hope the cat had recovered well.
A Cat Can't Pee On Labour Day
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date: 04 May, 2011
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
The above-mentioned case, probably recorded in 2000, was fished out from my archives as I am keeping all my cat's urinary tract problem cases under
http://www.sinpets.com/cats/20110433cats-urinary-tract-urethra-obstruction-infections-toapayohvets-singapore.htm for ease of reviews and for clinical research.
On Sunday, May 1, 2011 (Labour Day in Singapore), I was manning the front desk while Dr Vanessa Lin was doing the consultation. A man in his early 50s phoned me as his cat could not urinate normally for the past two days. I had a discussion with Dr Vanessa Lin on the management of this case as I would be having the afternoon off as each vet handles a case of urethral obstruction differently. When the patient recovers, everybody is happy. But should the patient gets worse or dies, litigation and complaints may occur and I don't want that to happen to Toa Payoh Vets.
There are certain standard operating procedures I will want to advise the owner and be recorded in case of medical negligence litigation and I had to inform my associate vets as I was taking the afternoon off. These are:
1. urine collection for analysis of crystals, bacteria and blood - mandatory. Some vets do not do this and may be sued for possessing a lower standard of care if the cat dies since the vet has no defence of urine or blood tests.
2. blood collection for health screening is strongly advised esp. to check whether the kidney is affected and whether there is a severe bacterial infection. Fever may or may not be an indicative sign of this infection. If the owner does not want to pay for this test, this objection must be recorded in the case sheets.
3. As to whether the urinary catheter should stay in this cat for 2 days, I left that option to her. However, I said: "Usually I don't stitch the catheter after thoroughly irrigating the bladder if the urethra obstruction is a recent event as in this case".
For long-standing cases, I do stitch the catheter for 2 days and may irrigate the bladder again. See my procedures at: The hissing cat has difficulty peeing again
CAUSE OF THE URETHRAL OBSTRUCTION/URINARY TRACT INFECTION?
In this cat, there was no urethral obstruction as the catheter passed into the bladder easily. I spoke to the owner the next day as he came for the cat. Monday, May 2, 2011 was a public holiday as May 1 (Labour Day) happened on a Sunday.
What was the cause of this cat's dysuria problem?
"FLUTD (Feline Lower Urinary Tract Disease) usually occurs in a male neutered cat over 5 years of age," I was thinking that this cat could have some injury or infection.
"My cat is only one and a half years old and he is not neutered!" the IT man said to me.
"5-years is the average age," I said. "Some cases happen in younger cats. Is your cat busy mating with other cats and thereby suffering from traumatic injury?"
"Well, my other cat keeps humping him every month. But this has been going on for several months and there has been no problem with urination."
I try not to be antagonistic and impatient. I said: "Many events don't happen until they are performed often enough. For example, people don't get prawn allergies till they are eat prawns for many times. It is possible that your cat has traumatic injury to the penile area."
I don't want to appear soliciting for business by advising neutering of the humping cats and therefore let sleeping dogs lie. This cat's dysuria is likely to be a case of traumatic injury. The cat owner will give canned food instead of dry food. I will follow up on the cat's urine and blood test results.
TOA PAYOH VETS' URL
http://www.asiahomes.com/singaporetpvet/0707cat_urolithiasis.htm
Tuesday, May 3, 2011
425. Lick granuloma in a gentle Golden Retriever. What to do?
His owner said: "I have been to your Surgery before but that was a long time ago. Vet 1 gave me a tub of cream to apply but the lump will not go away. What do you advise?"
I checked my records. I had vaccinated the Golden Retriever as a puppy and that was 5 years ago. Now this gentle dog has a big lump on the lower side of his right elbow.
"This is a case of a lick granuloma," I said. "It is hard to cure. I will manage your case with Dr Vanessa," I got the dog into the consultation room and informed Dr Vanessa that the owner wanted me specifically to handle the case. I would do the case with her since the owner did not object but I would be in charge.
"The elbow is a famous for hygromas," I said. "But this is not a hygroma. It is a lick granuloma. It can't disappear with the application of creams as it is quite large."
In the consultation room, I gave the owner 2 treatment options. One was steroid injection and the other was surgical excision. "I have not seen an elbow lick granuloma before," I said to the owner. "Lick granulomas are not common in dogs in my many years of practice. This elbow lick granuloma is a rare case for me. But I have seen other lick granulomas and have successfully treated two with steroid injections."
Singapore has nearly 90% of small breeds and lick granulomas are said to be more common in big breeds such as the Golden Retriever. I must organise my clinical research cases to show the conditions before and after treatment but time is so short.
P.S. Successful treatment of lick granuloma with chiropractic therapy, see:
http://www.avca.com.au/library/lick_granuloma.pdf
I checked my records. I had vaccinated the Golden Retriever as a puppy and that was 5 years ago. Now this gentle dog has a big lump on the lower side of his right elbow.
"This is a case of a lick granuloma," I said. "It is hard to cure. I will manage your case with Dr Vanessa," I got the dog into the consultation room and informed Dr Vanessa that the owner wanted me specifically to handle the case. I would do the case with her since the owner did not object but I would be in charge.
"The elbow is a famous for hygromas," I said. "But this is not a hygroma. It is a lick granuloma. It can't disappear with the application of creams as it is quite large."
In the consultation room, I gave the owner 2 treatment options. One was steroid injection and the other was surgical excision. "I have not seen an elbow lick granuloma before," I said to the owner. "Lick granulomas are not common in dogs in my many years of practice. This elbow lick granuloma is a rare case for me. But I have seen other lick granulomas and have successfully treated two with steroid injections."
Singapore has nearly 90% of small breeds and lick granulomas are said to be more common in big breeds such as the Golden Retriever. I must organise my clinical research cases to show the conditions before and after treatment but time is so short.
P.S. Successful treatment of lick granuloma with chiropractic therapy, see:
http://www.avca.com.au/library/lick_granuloma.pdf
Monday, May 2, 2011
424. Neutering a big breed - scrotal haematomas
Neutering is such a common surgical procedure in all veterinary practices. I was surprised that the other veterinary clinic did not want to neuter this gentle Golden Retriever as the vet rejected large breeds.
One cause of the other vet's reluctance could be the complications of neutering. One complication would be post-surgical scrotal haematoma due to haemorrhage as the dog licked and traumatised the wound. Over 48 hours, the scrotum became swollen to as big as a tennis ball in big breeds. Such cases are rare but had happened to me too.
What's the prevention advice. Basically, double ligation and sufficient post-operation pain-killers. One such case with no post-op problem is shown here, in 3 images.
One cause of the other vet's reluctance could be the complications of neutering. One complication would be post-surgical scrotal haematoma due to haemorrhage as the dog licked and traumatised the wound. Over 48 hours, the scrotum became swollen to as big as a tennis ball in big breeds. Such cases are rare but had happened to me too.
What's the prevention advice. Basically, double ligation and sufficient post-operation pain-killers. One such case with no post-op problem is shown here, in 3 images.
423. Sunday May 1, 2011 Interesting Cases - The 2nd case of a hissing cat
May 1, 2011 is a bright sunshine Sunday. Monday will be a holiday as May 1 is Labour Day. So, there would be a long weekend for leisure and the causeway to Malaysia would be clogged with cars from Singaporeans desperate to escape the concrete jungles of Singapore.
As I had spent 2 hours (not joking) inside a tour bus from Singapore to Johor Bahru (a 3/4-mile causeway) during one of such weekends to tour Malacca last year, I don't bother to waste so much time now to go on holidays to Malaysia on long weekends.
Things come in 3s sometimes. I had recently written about the case of the hissing cat with urethral obstruction. No news from the owner for the last few days after my follow up 24 hours after leaving Toa Payoh Vets. I presume they are happy with the outcome and I don't want to pester them since they have been asked to phone me if they have queries.
So, on this bright sunshine morning at 9.30 am, I was surprised to hear a cat hissing at my assistant, Mr Min. He was trying to get the cat spayed by Dr Jason Teo yesterday out of the cage to go home. The mother and adult daughter had come to pick up the cat to go home. The daughter helped by putting her hand in to take the cat out. A sudden swipe of the daughter's hand and she got a scratch.
So, what should Mr Vin do. Remember my report on Mr Vin being bitten on both hands by a cross-bred while helping Dr Teo to treat the maggot wounds? He was trying to muzzle the dog which was already tranquilised by Dr Teo. The dog bit him twice as he swung the muzzle onto the dog's face. Let sleeping dogs lie? I had to get him treated by the doctor and to teach him that he ought to use a big towel to cover the sedated dog's head instead of trying to muzzle. This dog was muzzle-shy as some dogs are gun-shy.
Now, he encountered a cat that swung her right paw out and hissed at him as he tried to get her out of the crate to put her inside the owner's top-opening carrier.
The cat hissed louder as he tried again. What should he do? "Thinking on your feet" is not easy for Mr Min as he still has many years of experience to know what to do. So he was bravely trying to get the cat out. His present procedure of opening the crate door and getting the cat out, if possible, would only get him wounded and the cat escaping. Becoming more ferocious. New clients would be arriving and witnessing such incident. I could foresee such a scenario. It would be a waste of time on this public holiday and time-wasting is not good for anyone.
"Has the owner a carrier that the cat can walk into?" I asked. The carrier was top opening and I don't expect a cat to just saunter into it.
"My daughter can get the cat out," the mother said.
"No, she can't", I said. "The cat had scratched her hand!"
This was the type of situation that required thinking on my feet.
What to do without traumatising the cat and the owners?
To make a long story short, I asked Mr Min to take a big towel to cover the crate's front and top. Then bring the crate with towel to the client's car. Put the crate inside, sit inside the car and go back with the client to their home. He took off the towel when he had the crate inside the car. "No, just cover the crate," I said. "The cat would feel more secure without seeing you."
As some clients don't bring back borrowed crates and bags, I had Mr Min to accompany the clients home. He came back soon as the clients were living nearby in Kim Keat.
He was unhurt and I hope he learnt something from me. Provoking an angry cat by trying to grab her out is not the solution. Unfortunately, it takes experiential learning to know what to do and everyone has to do it. Read widely. Some wisdom is also acquired from reading what others do and from asking the senior vets whom you have worked well with.
As I had spent 2 hours (not joking) inside a tour bus from Singapore to Johor Bahru (a 3/4-mile causeway) during one of such weekends to tour Malacca last year, I don't bother to waste so much time now to go on holidays to Malaysia on long weekends.
Things come in 3s sometimes. I had recently written about the case of the hissing cat with urethral obstruction. No news from the owner for the last few days after my follow up 24 hours after leaving Toa Payoh Vets. I presume they are happy with the outcome and I don't want to pester them since they have been asked to phone me if they have queries.
So, on this bright sunshine morning at 9.30 am, I was surprised to hear a cat hissing at my assistant, Mr Min. He was trying to get the cat spayed by Dr Jason Teo yesterday out of the cage to go home. The mother and adult daughter had come to pick up the cat to go home. The daughter helped by putting her hand in to take the cat out. A sudden swipe of the daughter's hand and she got a scratch.
So, what should Mr Vin do. Remember my report on Mr Vin being bitten on both hands by a cross-bred while helping Dr Teo to treat the maggot wounds? He was trying to muzzle the dog which was already tranquilised by Dr Teo. The dog bit him twice as he swung the muzzle onto the dog's face. Let sleeping dogs lie? I had to get him treated by the doctor and to teach him that he ought to use a big towel to cover the sedated dog's head instead of trying to muzzle. This dog was muzzle-shy as some dogs are gun-shy.
Now, he encountered a cat that swung her right paw out and hissed at him as he tried to get her out of the crate to put her inside the owner's top-opening carrier.
The cat hissed louder as he tried again. What should he do? "Thinking on your feet" is not easy for Mr Min as he still has many years of experience to know what to do. So he was bravely trying to get the cat out. His present procedure of opening the crate door and getting the cat out, if possible, would only get him wounded and the cat escaping. Becoming more ferocious. New clients would be arriving and witnessing such incident. I could foresee such a scenario. It would be a waste of time on this public holiday and time-wasting is not good for anyone.
"Has the owner a carrier that the cat can walk into?" I asked. The carrier was top opening and I don't expect a cat to just saunter into it.
"My daughter can get the cat out," the mother said.
"No, she can't", I said. "The cat had scratched her hand!"
This was the type of situation that required thinking on my feet.
What to do without traumatising the cat and the owners?
To make a long story short, I asked Mr Min to take a big towel to cover the crate's front and top. Then bring the crate with towel to the client's car. Put the crate inside, sit inside the car and go back with the client to their home. He took off the towel when he had the crate inside the car. "No, just cover the crate," I said. "The cat would feel more secure without seeing you."
As some clients don't bring back borrowed crates and bags, I had Mr Min to accompany the clients home. He came back soon as the clients were living nearby in Kim Keat.
He was unhurt and I hope he learnt something from me. Provoking an angry cat by trying to grab her out is not the solution. Unfortunately, it takes experiential learning to know what to do and everyone has to do it. Read widely. Some wisdom is also acquired from reading what others do and from asking the senior vets whom you have worked well with.
Subscribe to:
Posts (Atom)