478. Sharpei websites

http://sharpeiforums.com/viewtopic.php?f=2&t=816

http://www.kavishi.freeserve.co.uk/

Dr Sing,

Thank you for treating (name of Sharpei).
The above are the two sites I frequently go to.
There are a few more which I have yet to locate.
Can you send me a photo or two of the photo you took of my dog

Sharpei could not see clearly as he did not respond promptly to objects as before.
So the owner consulted me.

The dog had lower eyelid medial entropion. His upper eyelids' entropion was well done by the UK vet and had everted the upper eyelid. I noted generalised superficial ulcerative keratitis (cloudy cornea over 80% in both eyes). This explained why he could not focus as sharply as before.

What caused this superficial keratitits? Eye rubbing + ear rubbing over several weeks. His left ear was infected as he growled to warn me not to continue touching his ear. So, there was a problem. His neck skin was infected as signs of scratching were seen.

Skin scrapings by Dr Vanessa - no demodectic mites seen. "This negative finding does not mean he is not suffering from demodectic mange," I said. The owner said he was molting and therefore had those bare moth-bitten patches in his body.

477. Training a 5-month-old puppy advices

E-MAIL TO DR SING DATED JUN 20, 2011

Hi Dr Sing,

I was surfing the net searching for solution to train my puppy and I found your blog.

I have a terripoo puppy which is now 5 months old. When he was young, around 2months old, we used to buy the pee pan for him but he will not stop biting the wee wee pad. Therefore, we tried to lock him in the crane when all of us went out to work but it creates another nightmare by non stop barking. This has caused inconvenience to my neighbours and some of them had complainted about it. Due to this, my mom has decided to let him out from his crane and he is allowed to walk around in the house even none of us are home.

When he is out and no supervision, he will bite our furnitures and also pee pee anywhere he likes. My mom and I used vinegar to clean but still, useless. Can you please advise what should we do?


Best regards,
Name of owner



E-MAIL FROM DR SING DATED JUN 22, 2011


I am Dr Sing from www.toapayohvets.com. Thank you for your email.
It is difficult to advise on what you should do as each puppy or dog has a unique personality. Below are my general guidelines.

1. Confine the puppy to a room e.g. kitchen instead of a crate when he is home alone. A baby gate is placed at the door entrance so that the dog will not feel isolated. Confinement to a small area (crate, room, leashed area) is the basic factor to success of all puppy training programmes for most puppies.

He will bark at the beginning and possibly neighbours will complain. Give him chew toys that contain food inside (ask pet shops). Such chew toys with his favourite food occupy his time to try and get the food out. This may or may not work with your dog.

2. Develop a Routine. Morning and evening exercise outdoors daily for more than 15 minutes after meals and pooping in the designated confinement room. Do not interact with him while he is eating. After exercise, put him in the room as part of the routine.

3. Somebody must be the "boss" in the family. Firm voice of "No barking" and rewards for performance of no barking (go out, treats). Read your dog obedience books to know what I mean.

4. Neuter him at 6 months of age.

5. Supervise him when he is let out to roam free in the apartment and use the firm voice to train him as mentioned in paragraph 3 for barking, chewing, indiscriminate peeing and pooping.

6. I have heard of cases of success (barking and obedience training) when the puppy is boarded at a trainer's place for two weeks or more. Consult a good dog trainer.

I hope the above tips will help. Best wishes.

476. Red-eared slider - rectal prolapse - purse string suture

Sunday's Interesting Case. Jun 19, 2011. Bright sunshine day.

A red-eared slider owner had made an appointment to see me at 9.30 am on Sunday.

5-year-old red-eared slider
"How long has the rectum come out?" I asked the owner.
"7 days," he said. "It happened some weeks ago and a vet had stitched up the rectum. After 7 days, he took the stitch out and there was no problem. What is the cause?"

"Something has irritated the rectal area," I said. "Usually it is foreign bodies, parasites or diarrhoea."

"It was due to constipation," the gentleman said he kept the slider in a tank with dry and wet areas and had fed her pork meat, chicken meat and the green sticks of commercial turtle food. "I will stop feeding the green sticks," he thought these were the ones causing constipation.

"The slider may not be drinking water in the tank if it is dirty and contaminated?"

"I change water every day," the man said.

So it is hard to know what causes this rectal prolapse as he seemed to have maintained the terrapin well for the last 5 years. The shell was in good condition with no cracks or abrasions on the shell and of good normal size. No peeling or discoloration. Active. She looked healthy.

ANAESTHESIA
Gas mask. Isoflurane gas at 5% in short duration to effect. There was some "clicking" noises of less than a second during anaesthesia. The turtle was anaesthesized just sufficient to put a purse-string suture to close up the anus after pushing back the rectum inside the anus.

PROCEDURE
1. An assistant puts the gas mask onto the turtles head and focus on her reaction.
2. A 2nd assistant holds the turtle upright but NOT upside down on her back, as the slider will suffocate.
3. I  clean the rectal prolapse with normal saline and pushed it inside the vent.  Then I insert a 2.5 ml syringe into the lumen of the rectum to prevent prolapse. The 2nd assistant held the syringe inwards as the slider may strain to cause prolapse
4. Stitch 3/0 nylon cireumference of anal opening, like a purse string.

DURATION OF STITCHING
7-10 days. The cause of the rectal prolapse must be known otherwise it will be difficult to prevent another episode.

I advised clean water (water left overnight to get rid of the chlorine and asked the owner to check whether the slider actually drinks by giving her the clean water directly.)

Antibiotics and anti-inflam oral for 7 days.

Stitches removed 7 days later. No more prolapse.  

CONCLUSION

Prompt vet treatment and slight prolapse give good chances of recovery to normal.

475. Rare case of pyometra in a young female dog

After over 30 years in small animal practice, I thought I have seen all pyometras. Pyometra is an infection of the womb in the female dog, mostly in dogs over 5 years old.

Yet, this female dog just had her first heat 2 months ago. I checked her before spay and saw mucoid yellow vaginal discharge. "Is she really 10 months old?" I asked Mr Min, my assistant. She was as her teeth were all white as snow and her puppy canine tooth was still present and white.

I am happy to say she is OK after spay. Small animal veterinary medicine is full of surprises every day.

474. Watery pus in shar pei's eyes - entropion?

I have a 6 years old male Shar Pei and have been having watery
eyes and yellow sticky discharge.
I am cleaning him a few times a day with eye wash and the problem
keep coming back.
I understand that surgery on the eye lid is necessary to stop this problem.
Can I know what will be the total cost for this surgery. And how long do I
have to leave him there.


E-MAIL REPLY BY DR SING
I am Dr Sing from Toa Payoh Vets. Thank you for your email. Estimated costs are around $600 - $700 for both eyes as general anaesthetic gas is used. Bring the dog in at 9.30 am and bring home in the evening. No food and water the night before after 10 pm. Phone 9668 6468 or 254 3326 for appointment.


Costs include all fees and medication.
Blood test to check whether the dog is healthy is not included and is advised. Cost is $150. However, this depends on the owner as to whether he wants the blood test or not.

E-MAIL TO DR SING DATED JUN 16, 2011
Can I make a appointment to consult Dr. Sing tregarding my dog's eye and to advise
if he needs entropion surgery.
Mon.11.30am or Wednesday, or Thursday 11.30am or but not Tuesday.
Please call me to confirm the appointment.
Thanks !

Ande Lai h/p  xxxx



- Show quoted text -

473. Deep eye ulcer in a 3-month-old Shih Tzu puppy

Yesterday, Jun 16, 2011, I operated on a 3-month-old Shih Tzu with corneal ulcers on both eyes. The owner was referred to me by the sister who had sent the hamster with the large cauliflower ear wart to me 3 days ago.

I am still much worried about anaesthesia of 3-month-old puppies as they are not strong enough.

"No injection?" Mr Min asked me as he has been used to vets giving sedation and then gas anaesthetic for the last 2 months or so. He had replaced Mr Saw and was new to the small animal veterinary world although he had some experience in Malaysia and had graduated some 10 years ago in Myanmar.

"Only isoflurane gas," I replied. "If you know how to do it." I showed him how to hold the puppy and give anaesthesia gas via the mask. "Hold the scruff of the neck, angle the head at 45 degrees and give the mask," I said. Yet he did it his way and when I corrected him, he said "I don't want the mask to touch the corneal ulcer!"

It needs a lot of impatience to teach the young ones and sometimes I feel that they just want to do it their own way. I said: "At 45 degrees, the puppy can breathe normally. At 90 degrees (to the mask), it is unnatural and the gas cannot flow through smoothly!". Teaching Min is important as he assists my two other associate vets who have their own styles. But there must be one standard operating procedure which is safe, efficient and least costly (wasting of the very expensive isoflurance gas).

My previous technician, Mr Saw had learnt what to do after 3 years of working with me, but he had decided to retire to greener pastures in Yangon where he was promised a "partnership" in a practice. So, a new technician had to be supervised and mentored again.

For this puppy, the owner is very worried, as do all owners of puppies and parents of babies. The anaesthetic risk is so much higher and it was no surprise that the vet near her apartment had prescribed just antibiotics eye drops and atropine eye drops and vibravet oral tablets. Then she was referred to the parent company's vet who was unfortunately fully booked. So, that was how the case came to me from my successful handling of the hamster with the large ear wart with Dr Vanessa 3 days ago. Well, if the hamster had died under anaesthesia, I doubt this referral would come. So much depends on the anaesthetic outcome in veterinary anaesthesia.

HOW THIS CASE WAS DONE
1. Isoflurane gas by mask at 5%. Observe signs of surgical anaesthesia by me. Don't depend on inexperienced vet technician Min. Proper angle of the neck and nose at 45 degrees.

2. Intubate just when the puppy was not fully anaesthesized. Be alert. There was a "vomiting" sound. I quickly pulled out the endo-tracheal tube but there was no vomiting. If negligent, the vomitus goes into the lungs.

3. Give 2% isoflurane. The temptation of the technician or vet is to give 5% via the tube as the puppy moves. Close the mouth with hands and be patient. It takes time for the puppy to be under surgical anaesthesia.

4. Flush hairs and debris off the eye thoroughly. Ensure the 3rd eyelid is opened up and irrigate all hairs trapped inside.

5. Check eye is clear of debri. I put in terramycin eye ointment and the atropine drops.

5.1 In infected eyes, I do inject subconjunctival gentamycin but not in this case as it was 4 days old.

6. A horizontal mattress suture, 3/0 absorbable sews up lower and upper eyelids. Eye-lashes must be completely shaved off.

7. E-collar. The puppy wakes up fast as if she has a short nap.

DISCUSSION WITH A 5TH YEAR VET STUDENT FROM MURDOCH UNIV
Each vet has his own approach. The student, Daniel said he would swab the ulcer, get a bacterial culture. Give appropriate eye drop antibiotics, atropine, e-collar and let the ulcer heal. NSAID pain-killers. Perhaps an eye patch.

IN REALITY
The first vet had essentially prescribed what Daniel had proposed except for NSAID. The owner had great difficulty putting eye drops on the puppy as the naughty one shifts right and left. Both corneas were ulcerated (will show images later). Puppy's sclera gets redder by the day. Itchy, rubbing eyes.

LEFT EYE
Deep ulcerative keratitis. The cornea ulcer of the left eye was deep. A red blood vessel forms at 11 to 2 o'clock above this ulcer.

RIGHT EYE
Superficial ulcerative keratitis from 6 o'clock to 11 o'clock.

So, the owner is worried that the puppy will become blind.

472. Sharing knowledge of veterinary anaesthesia from Malaysia

Many Malaysian vets I meet during continuing education talks have found the following effective for injectable general anaesthesia. Here is one from a helpful vet in Johor Bahru.

Hi there Dr. Sing,

For me, in terms of injectable zoletil most of us vets here uses the TKX mixture. here is how you do it:

1. take zoletil 100
2. discard the water diluent
3. mix 2 ml of xylazine 100mg/ml
4. mix 8 ml of ketamine 100mg/ml

then you will have 10ml of TKX (zoletil plus ket plus xylazine) where 0.1ml of this tkx should knock down an animal about 3kg for a decent 15-20 minutes. very good for short procedures and also the muscles are quite relaxed unlike those if you use in pure zoletil.

i personally use my own concoction of 3ml xylazine and 7 ml ketamine and i find that this mixture gives me a knock down of 20-25 minutes and the animal 'sleeps' longer. i maintain my animals on gas if the procedure takes any longer than 15 minutes. the only worry is the chance of hypotension (due to xylazine) and we should be mindful of older animals or those with cardiac insufficiency.

COMMENTS
I have seen the above TKX used effectively in cat spays in NANAS, an animal shelter in Johor some 2 years ago. It is said to be safe.