526. Four packets of stitches to spay a female dog is extravagance

Best Time To Spay Your Female Dog
- A Dream Spay
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: 23 November, 2007
Update:  31 July, 2011

When the dog owner is well informed, a spay operation in the female dog can be a very smooth operation taking less than 30 minutes.

Today was such a day. The Miniature Schnauzer, born in Dec 3, 2005 was on heat 4 months ago. She was spayed today Nov 23, 2007 as the owner was advised to do so 3-4 months after heat and she made the appointment at the 4th month.

My assistant Mark talked to the dog as he put the face mask over her muzzle. She did not struggle and went to sleep under 8% gas anaesthesia within 10 minutes. No tranquilisation was needed. I inserted the endotracheal tube to connect her lungs to the anaesthetic machine, maintained the anaesthesia at 1.5%.

The incision was 2.5 cm from the umbilicus. A 1-cm cut into the skin and the linea alba to access the internal organs of the womb and ovaries. I inserted the spay hook into the abdomen by turning it towards my right at 45 degrees caudally.

It hooked out the left uterine horn. I pulled the left ovarian ligament. The dog started to breath much faster as she felt the pain. My assistant increased the gas to 8% for a minute so that the dog had more gas to remove the pain of surgery. The minimal amount of gas given will lead to no deaths and that was why I used 1.5%.

No more rapid breathing observed. I cut the ovarian ligament with the scalpel. Clamped the ovarian stump. Ligated the stump. Then I pulled the left uterine horn totally out of the body and saw the right uterine horn at the uterine body junction popping out. I used forceps to pull it out.

From there, I accessed the right ovarian ligament and repeated the same procedure as with the left. No bleeding. The blood was normal red with oxygen. The dog was breathing regularly. Finally, I took out the uterine body, clamped and ligated it. It was let go into the abdomen.

The skin and muscles were stitched up. The gas anaesthesia was switched off as I stitched the skin. No bleeding from the ovarian and uterine tissues at all as the dog was no longer on heat.

The dog woke up smoothly after 3 minutes. An Elizabeth collar was given to prevent licking of wound. Overall, this was a dream spay. It was the most satisfying spay I had ever done as everything proceeded smoothly, there was no bleeding and therefore the surgical time taken was less than 30 minutes. The dog woke up by the last stitch as I had the gas reduced to 0% during stitching which is usually one horizontal mattress stitch. She went home without complications post-operation as the owner did not phone me nor came for stitch removal, thus saving time for him.

QUESTIONS THE OWNER ASKED:
1. Bathe the dog? Yes, but make sure the plaster is not wet.
2. Can the dog eat any food? Yes.
3. When to come back to remove the stitches. No need. The absorbable stitches will dissolve and fall off in 14-28 days.
4. When to remove plaster? 7 days later.
5. Can give antibiotic and pain-killer tablets crushed and mixed with water inside a syringe? Yes.
UPDATE IN JULY 2011

ANAESTHESIA IN TOA PAYOH VETS
A new isoflurane vaporiser has been installed in July 2011. Maximum is 5%. The dog is usually sedated with xylazine or domitor before isoflurane gas is given by mask and then intubation.

USE OF SUTURES IN SPAYING A FEMALE DOG BY DR SING
For dogs in general, I find that one packet of 2/0 absorbable sutures is sufficient, even for big breeds like the Siberian Husky. From my over 30 years of spaying dogs, I find that there is no need to do a subcuticular sutures. One horizontal mattress suture closes the skin as shown below.

ADVICE TO NEW VETS
There are employee vets who use two packets to spay a female dog as they don't need to account for the bottom-line.

In July 2011, I discovered a vet who used 4 packets of sutures (2 packets of "0" chromic catgut and 2 packets of "3/0" absorbable monofilament) for pyometra surgery in a Maltese. This is extravagance from this vet who does not have to pay for the sutures herself. There is a need for a new vet to be prudent and to keep surgery simple and safe for the dog. In this case, 2 packets of sutures will be more than sufficient and that will be the industry's bench mark.

Keep spay simple for the dog by using minimal suturing. Less sutures mean less irritation and itchiness during healing. There is no need for subcuticular sutures. If you feel the need to impress the client by using "subcutaneous" sutures (sutures under the skin) so that the client does NOT see any sutures on the skin, you need to have excellent stitching skills. No point showing the sutures or stitching another appositional layer if you want to impress the client.






A RARE CASE OF PYOMETRA IN A VERY YOUNG FEMALE DOGPyometra in a very young female Silkie Terrier is very rare as this womb infection occurs usually in female dogs over 5 years of age. By spaying her, the owner prevents pyometra which can cause death in some female dogs.


Photos and more details at:
http://www.sinpets.com/stories/20090520Spaying_Female_Dog_ToaPayohVets.htm

524. Survey on post-op licking of wound by a male Yorkshire Terrier after neuter

Surveys are important to assess the efficacy of the pain-killer tolfedine which I usually prescribe for dogs after surgery e.g. neuter and spay. Tolfedine is a NSAID. It has anti-fever effects as well as pain-killer. Below is one survey by e-mail feedback from the owner.

E-MAIL TO DR SING DATED JUL 12, 2011
On Tue, Jul 12, 2011 at 6:39 PM,

Dear Judy,
I have a one year old Yorkie that we want to neuter. Please advise how much will the procedure be and when is the earliest time that we can bring him down. You can reach me at .... if you need any further info.

Thank you.

Best regards,
Name of owner

E-MAIL REPLY FROM DR SING DATED JUL 12, 2011

Thank you for your email I am Dr Sing from toapayohvets.com

The cost of anaesthesia, surgery and post-op pain-killer and antibiotic injection is estimated to be around $150-$200 for dog breeds less than 5 kg and without surgical complications and have two descended testicles. You have a choice of 3 vets, namely myself, Dr Vanessa Lin and Dr Jason Teo.

If you want me to neuter him, please bring him down at 9.30 am from Monday to Friday. No food and water after 10 pm the evening before surgery. Phone 6254-3326 for appointment. The dog will be operated at 10 am and goes home around 12 noon or later in the day if you are not free. The dog should preferably be vaccinated within one year and in good health. Bathe the dog first and clean up his lower area.

Best wishes.

E-MAIL TO DR SING DATED JUL 16, 2011

Hi Dr Sing,

Can I book an appointment with you this coming Thurs? I'll bring him down at 930am and pick him up later part of the day. Look forward to your confirmation.

Best regards

E-MAIL FROM DR SING DATED JULY 16, 2011

Thank you for your email. Thursday 9.30 am will be OK. Will see you this Thursday.

E-MAIL FROM DR SING DATED JULY 23, 2011

Hello
I could not contact you by phone to enquire the post-operation situation in your dog. Please let me know whether your dog is recovering well with no bruising trauma to his operation area and when you give the medication of tolfedine.

Best wishes.

E-MAIL TO DR SING DATED JULY 23, 2011

Hi Dr. Kong,

He is doing well except that he looks kind of tired which I expect from the op. Please advise when can we remove the plaster from the op area. Thanks.


Cheers.
E-MAIL FROM DR SING DATED JULY 25, 2011
Plaster can be taken out on Day 7 and clean wound. He should be OK, not tired after Day 3.

E-MAIL FROM DR SING DATED JULY 25, 2011

Further to my email, please let me know whether your dog has tried to lick his surgery area and the dosage of painkiller tolfedine and duration (at what time) you give to him as your sister was the one present at the Surgery. This is because I am gathering some info on the usefulness of tolfedine on Yorkshire terriers. If he does not lick his surgery area, then it is effective.

Best wishes

E-MAIL TO DR SING DATED JULY 25, 2011

Hi,

Even with the neck guard (not sure what is the term for it), he have managed to find ways to lick his wounds….He is recovering well but seems that the antibiotic did not work well as he does want to lick his wounds.. His plaster came off last night. Wound area seems to be quite okay.

Cheers
E-MAIL FROM DR SING DATED JULY 27, 2011

Can you let me know the estimated times per day and how long you gave him the tolfedine painkiller tablets?


E-MAIL TO DR SING DATED JULY 27, 2011

Estimated times per day in terms of licking the area? I am not too sure but based on what my maid told me… As much as possible when he can push the collar off in the position where he can lick it. The painkiller was given as instructed.


Cheers

E-MAIL FROM DR SING DATED JULY 28, 2011
Thank you for the feedback. I am glad he has no big problems.

CONCLUSION

Two Yorkshire Terriers of similar ages were neutered at around the same month. Both had normal testicles inside the scrotum. No post-operation complaint. As the dogs were given 2/0 absorbable stitches, I don't get to see them 14 days after operation as in the old days as the stitches will drop off after 21 - 28 days usually.
Tolfedine is given once a day for 4 days at 4mg/kg orally from Day 2. From Day 1, after the operation, the dog will be given a tolfedine injection as well as a baytril injection SC. In the above Yorkshire, I advised tolfedine oral twice a day for Day 2.

As for adult male dogs trying to lick the surgical area, this is a common post-operation behaviour. Tolfedine, an NSAID and anti-fever drug reduces the pain and inflammation and much less post-operation licking in most dogs, in my experience. Sometimes, the owner forgets to give on time, and this may result in vigorous licking and bleeding.

Surveys after surgery and from customers are very important for any enterprise. When I went to visit Malacca on a Saturday July 23, 2011, I noted that the tourists were given some survey forms. I post a picture of two pretty tourists writing their opinions on a form for readers to appreciate the beauty of the two English roses.


Updates and pic are at:
http://www.sinpets.com/F5/20110731survey-tolfedine-post-op-Singapore-ToaPayohVets.htm

Bilateral cryptorchidism surgery

On this bright Sunday, July 24, 2011 morning, I was preparing to operate on the Silkie Terrier with "the mother of all perineal hernias" as described in Perineal hernias in a Silkie Terrier repair pictures. Update on a Boston Terrier's perineal hernia. The dog had his hernias repaired 11 days ago. However, the skin where his herniated bladder and intestines had crushed had little blood supply and the cells started dying. This is called gangrene.

A young couple arrived promptly at 9.30 am as they had made an appointment with me. They wanted to neuter a good looking solidly built miniature 2-year-old "miniature" Bull Terrier.

A hyperexcitable dog, resisting handling and turning upside down to examine his testicles which were not present inside the scrotum as in normal male dogs.
 
"Listen to the whistling sounds," I handed the hearing piece of the stethoscope to the husband so that he could listen to the whistles. I could hear the heart sounds separately but the continuous whistling sounds blocked out the heart sounds. This sounds reminded me of a condition similar to the racehorse - laryngeal hemiplegia.

"They are heart sounds," the husband declared. I asked if he had medical training but he had none. He heard loud distinct whistles in the stethoscope and therefore deemed them to be heart sounds.

"Well, they are lung sounds," I said. The heart sounds were muffled and he could not hear them since he had no experience with dog heart auscultation.

SYNCOPE
It was in 1974 when I was in my 5th year of veterinary studies at Glasgow but I still remember the word "Syncope" mentioned in my veterinary lectures. At that time, syncope was a word meant to be remembered for the examinations. I seldom encountered this transient fainting and spontaneous recovery after a short while in dogs in my over 30 years of practice. This miniature Bull Terrier appeared to be suffering from this condition and more detailed heart examinations including the ECG will be needed.

The dog has a history of fainting when over-exerted. "When he plays vigorously with the bigger and younger 8-month-old standard Bull Terrier, he could just simply collapse, as if out of breath and lie down for a while. Then he would recover completely. As if he has caught his breath and behaves normally."

This bit of information from the husband is valuable. It indicates that this dog has a cardio-pulmonary problem. He is a highly risky candidate for anaesthesia. I checked the gums. Excellent pink colour. However, the left inside lip had a yellow ulcer and several holes. "Bitten by the other bull terrier?" I asked. "Probably," the husband said. "They bite each other."

Two undescended testicles. With the dog upside down, I could palpate the left one. The right one was barely felt as it slipped inside the body. "My advice is to prepare for general anaesthesia rather than just take out one. When the dog is down, his right testicle may just disappear inside. Under anaesthesia, I can open up the abdomen and locate and get it out. (Undescended testicle can become cancerous years later). Neutering was to reduce his hyperexcitability.

BLOOD TEST
The couple agreed to the complete blood test. The liver enzymes were high while the platelets were below normal.
"Why?" the husband asked.
"Did you feed herbal or other supplements?"
"Yes," he said. "One iodine capsule per day since he was a puppy."
"Is the dosage recommended for the dog?" I asked.
"I gave one capsule as recommended for adult people," he said.

HIGH ANAESTHETIC RISKS
Based on his history of syncope, the liver disorders and low platelet count, I advised against surgery for the time being. Another blood test can be taken 4-12 weeks later. Definitely, no more iodine or other supplements and wait one month for another blood test.

The liver could have had been damaged by the iodine and its other ingredients consumed over the past 2 years. "It is not just iodine alone inside the capsule," I said to the husband. "The manufacturer will add other substances. Over the years, the liver could have been damaged. As to why the dog was given iodine, I did not ask the owner. It was good that he agreed to a blood test.

UNDESCENDED TESTICLES if normally felt under the skin can be easily removed via skin incisions as shown in the case of the poodle below. In this miniature Bull Terrier, one testicle is barely felt.

To save on veterinary cost and the need for another operation to open up the abdomen to remove the hidden testicle, it is best to put the dog under general anaesthesia, open up the abdomen, locate and remove the abdominal testicle inside as well as to remove the inguinal testicle under the skin.

INFORMED CONSENT
If the dog is healthy, there should be no anaesthetic risk but this miniature bull terrier has some health problems. So, the owner has to take the risk and be given proper information of the risks and options (informed consent). It is best that this be recorded in the case files, in case of litigation and complaint when the dog dies on the operating table.

NEGLIGENCE AND REMOVAL OF THE HIDDEN ABDOMINAL TESTICLE NEEDS A LONGER SURGERY
In some practices, since the dog has only one undescended testicle felt under the skin, this is only one that will be removed during the traditional neuter while the abdominal one is not as that necessitates opening up the abdomen, prolonging anaesthesia and increasing the risks of dying on the operating table. This is not in the interest of the dog or owner as the hidden testicle inside the abdomen can become cancerous in old age and I had seen some cases (revealed by X-ray). A negligence litigation suit may result.

Therefore, the owner must be well advised and both testicles must be removed. Not just the one under the skin. The hidden testicle is usually seen located just below the mid-penile area and can be hooked up to be tied and taken off.

Cryptorchidism can be either bilateral or unilateral, and inguinal or abdominal (or both). This poodle has bilateral inguinal cryptorchidism. Therefore you can see both undescended testicles under the skin. In abdominal cryptorchidism, the testicles are inside and there is a need to open up the abdomen to take out the "hidden testicle."


 In the case of the miniature bull terrier, one testicle is in the inguinal and one is retracted into the abdomen when the dog is held upside down. Neutering or castration is strongly advised as there is a high chance of the undescended testicle becoming cancerous in older dogs.

Pictures of bilateral cryptorchidism are at:
http://www.sinpets.com/F5/20110730syncope-undescended-testicles-miniature-bull-terrier-Singapore-ToaPayohVets.htm

523. Food and dog treat allergy cases in two female dogs

Friday, July 29, 2011. Half a year had flown by! I am still practising but I sometimes still do the routine cases of spay and neuter at 9.30 am and handle the complex difficult cases such as the Silkie with the big backside perineal hernias as written in: Perineal hernias in a Silkie Terrier repair pictures. Update on a Boston Terrier's perineal hernia

I narrate two recent interesting skin disease cases I chanced upon as they seem to be associated with dog treats.

CASE 1.
Yesterday, July 28, 2011, Dr Vanessa left at 6.30 pm as she had asthma the day before. Actually she had informed Min that she would be back 3 days later. I quickly informed her clients to postpone her appointments as I don't want them to be upset when they come.

Veterinary medicine at Toa Payoh Vets is much personalised and since she handles most of the day cases, most of my clients get used to consulting her since I seem to have "retired." Succession plan is taking place as I am over 60 years old and must leave space for the younger ones to bear the responsibility and learn from practising. I do intervene in my associate vets' cases when I need to.

One of her clients was looking for her today and she suddenly appeared after 11.00 am and so I passed the male cat couple whose daughter wanted her to neuter him. I was manning the reception counter while my assistant Mr Min went for dinner.

Suddenly, an old client with a 4-year-old Maltese X came in for vaccination. She was abandoned and was adopted by this man in his 40s as the 4th owner. The man reminded me that I had diagnosed some urination problem. "It is called submissive urination," I said. "She would empty her bladder when any person approaches her. Is she better now? Confidence build up will lessen her problem. Bring her out more often."

The busy printer owner said: "I only bring her out to pee and poop once a day. Then it is back to the apartment. She definitely has better control of her bladder. When she sees other dogs when we go out, she will bark loudly."

"Does she pee?"
"No, but she will run away after barking."

"You ran out of Hills' ZD diet and so I went to the pet shop to buy Hills' Skin Sensitive Diet since they can't sell Hills' ZD diet. My dog now no longer itches. Hills' brand is very good. Anyway, the ZD produces a very sticky dog poo and so it is not good for me. This Sensitive Diet produces well formed stools that do not stick to the floor as you can see!"

The dog pooped 2 lumps. I used a toilet roll tissue to pick up the two stools instead of ordering my assistant who had just come back from dinner.

"It is not any Hills' brand that resolve your dog's skin itchiness problems," I reviewed his dog medical records. I spayed the dog in June 2011 and prescribed Hills' ZD diet twice. He switched to the Hills' Sensitive Skin diet since I ran out.

Very little scratching except for some black ear wax. One of two scabs in the belly and chest sternum. He as very happy as his dog had this skin problem of itchiness and hair loss for over two years before spaying. She had received treatment for ringworm and had her shampoos.

To the owner, the dog no longer itches and he does not need to cook home-cooked food for the dog, an inconvenience. Just feed this Hills' brand.

In my experience, spaying sometimes do resolve the skin itchiness. As to why, I don't know but it has been reported by some vets and I had a small number of dogs recovering. However, this dog also is no more given the dog treats unlike last time. It is possible that she could be allergic to dog treats in the first place. Eliminating dog treats resolved the problem. Spaying to remove hormonal imbalance. Nobody knows scientifically why this dog has no more skin itchiness problem.

CASE 2.
On the previous day, that is, Wednesday, July 27, 2011, I went to the Surgery at 8 pm to do a surprise check. It is a heavy responsibility being the licensee and founder, but such audits need to be done as the Toa Payoh Vets practice I founded is still a rebellious teenager and needs my personal attention.

Around 50 vet practices have sprung up in Singapore in 2011 and the old practices can be complacent and go bankrupt if poorly managed. Success is not a given in any business or medical practice just because the practice is established as competition becomes more intensive. Success depends much on the vets or doctors but the management of the practice (quality of veterinary services, over-ordering and unnecessary use of products by associate vets, clinical outcomes by vets, economics, human resources, strategic planning, amongst others) is extremely important

Dr Jason Teo was to be on duty at night. An adult daughter and her mother with a spayed female Maltese came in. They had consulted me 3 weeks earlier about itchiness in this dog's ears, elbows, armpits, groins, paws. Just scratching and scratching and I had asked for a review 3 weeks later. They don't mind consulting Dr Teo too as they had seen him earlier.

"Well, the dog started scratching 3 days ago, when your medication was finished," the daughter said. "So we come in for a review." As Dr Teo had not arrived, I checked the medical records. I examined this dog. Eyelids rubbed red. Ear pinnae flamingly reddish pink. Four paws itchy and licked. Elbow front show reddish bloodied streaks due to licking. Groins reddish. Armpits were OK for the time being. These were signs of allergies which had been present for the last two years. What is the cause?

Dr Teo arrived soon and I asked him to come in to collaborate on this case and to do a proper recording. He would be opening his own practice and it is good that he does so since he has been with me as an associate vet for at least 4 years.

"Do you give dog treats?" I asked the mother and daughter who expected more anti-itch medication, drugs and shampoos.

"Yes, I just bought a big bag of treats."
"No treats. Just switch over to Hills' D/D diet for 2-3 months," I said. "Not even one treat."

"My dog can't survive without any treat," the mother said. "What do I do with my big bag of treats?"

"After 3 months of feeding Hills' D/D diet and if the dog does not itch anymore, you can give the treats," I said. "If the dog starts being itching again, then you know it is due to the treats. Give 90% of the old dog food and treats for the first 3 days, then slowly change to 100% of D/D in 14 days," I advised.

As to whether the owners will comply, it is hard to say. This Maltese is definitely a case of generalised allergy. It was no longer generalised ringworm as in the past. Ringworm is also a very itchy skin disease for most dogs.

As to the exact cause, it is hard to say unless the vet knows all about the dog's lifestyle and environment. For starters, I advise an anti-allergic dog food and if this works, there will be much happiness and convenience as well as money saving for the owners.

These two cases are examples of allergies with one cause being the various brands of dog treats being given. Prescription diet for dry dog food allergy may be one way to elimination of the cause. Spaying may help too.

522. A hamster's orange urine - ageing or illness?

E-MAIL REPLY TO DR SING DATED JULY 29, 2011
Hi Doctor Sing,

Hope this email finds you well.

I've another dwarf hamster (1yr 7mths old, male). Recently, i noticed that his urine turns darker in colour. Last week, it was kind of orange and this week slightly better as you can see in the attached picture.

When I flip him over, i noticed that his fur around belly & bottom area have also turned yellow/orange from the urine stains which cannot be removed with water.

Despite so, his appetite & bowel movement remains normal just that his breathing/heart beat seems a lot faster even while he's asleep.

Appreciate your advice if this is normal in aging hamster or could it be sign of any illness that requires medical treatment.

Enclosed is the picture for your review.

Thank you for your time and hope to hear from you soon.

Best regards,
Name of lady owner


E-MAIL REPLY FROM DR SING DATED JULY 29, 2011
Thank you for your email. It is very difficult to know what is the cause of the urine stains or change of colour unless a urine sample can be collected for urine analysis.

Your picture of urine colour shows some orange or reddish colour of urine as well as yellowish urine but no diagnosis can be made based on colour. The urine needs to be collected and analysed by the laboratory.

A change of urine colour may be due to a kidney disorder, urinary tract infection, urinary tract tumours, food colouring, traumatic injury (falling down from climbing cage) to the bladder and kidneys or other reasons.

I advise
1. collecting a urine sample via a plastic bag or come to the Surgery for me to collect a urine sample.
2. Let me know how much water he is drinking. Is it more than normal?

With best wishes.

With best wishes.

Sunday's interesting cases - stitching up a big backside gap

Sunday at 9.30 am was scheduled for me to stitch up the poor Silkie's big backside holes. He had a big Taiwanese mango lump in his backside some 10 days ago. The intestines and bladder popped out from his pelvis and rubbed against the skin. He licked till the skin became paper-thin and you could see the intestines just lying under. The blood supply and the subcutaneous fat and skin dermis layers were almost wiped out. No blood flowed. So, the area became white as snow (see pictures).

After I repaired the 3 hernias, the thin skin became gangrenous. So, the skin died day by day and 3 big hole appeared. I took 1 hour to re-do and re-stitch. If not done, the stools just drop into it.

520. Sunday's interesting case. The whistling Bull Terrier

Sunday

A young couple wanted to neuter a good looking solidly built miniature 2-year-old Bull Terrier and came at 9.30 am on Sunday July 24, 2011.
A hyperexcitable dog, resisting handling and turning upside down to examine his testicles.
"Listen to the whistling sounds," I asked the husband to listen to the stethoscope. I could hear the heart sounds separately but there was a continuous whistling sound, as if the dog has a condition similar to the racehorse - laryngeal hemiplegia.

"They are heart sounds," he said. Loud distinct whistles. "Well, they are lung sounds," I said. The heart sounds were muffled. Well, the dog had a history of fainting when over-exerted. When he played vigvigorously with the bigger standard Bull Terrier, he could just run out of breath and lie down for a while, as if to catch his breath.

A highly risky candidate for anaesthesia. I checked the gums. Excellent pink colour. However, the left inside lip had a yellow ulcer and several holes. "Bitten by the other bull terrier?" I asked. "Probably," the husband said.

Two undescended testicles. With the dog upside down, I could palpate the left one. The right one was barely felt as it slipped inside the body.
"My advice is to prepare for general anaesthesia rather than just take out one. When the dog is down, his right testicle may just disappear inside. Under anaesthesia, I can open up the abdomen and locate and get it out. (Undescended testicle can become cancerous years later). Neutering was to reduce his hyperexcitability.

BLOOD TEST
The couple agreed to the complete blood test. Fortunately, this was done as the liver enzymes were high while the platelets were below normal. "Why?" the husband asked.
"Did you feed herbal or other supplements?"
"Yes," he said. "One iodine capsule per day since young."
"Is the dosage recommended for the dog?" I asked.
"One capsule is for adult people," he said.

I advised no surgery, no iodine or other supplements and wait one month for another blood test. The liver could have had been damaged by the iodine and its other ingredients. "It is not just iodine alone inside the capsule," I said to the husband. "The manufacturer will add other substances. Over the years, the liver could have been damaged.

519. Advantix spot-on for dogs only, not for cats - update

The following has been updated today as there was an error in the earlier article stating that imidacloprid is toxic to cats. Bayer Thailand pointed out this error, namely that imidacloprid is safe for use in cats but it is permethrin that is toxic in cats. Since Advantix contains imidacloprid and permethrin, it is NOT safe for use in cats e.g. in the treatment of FAD (flea bite dermatitis).

On March 13, 2010, I attended a continuing education programme "Canine Vector-Borne Diseases in Pet Practice - Focused on Singapore" conducted by Dr Susanne Siebert. The contents were mainly on diseases transmitted by ticks, fleas, mosquitoes and sand flies. Heart worms and intestinal worms were discussed too.

For 4th & 5h year students, veterinary parasitology and pharmacology can be very boring as there are so many names and drugs and their efficacy, safety, ease of application, treatment schedule and ability to only treat or treat and prevent. How is the lecture relevant to the real world? I hope the following summary of my comments on "Bayer Parasite Solutions" may make their studies more enjoyable and in case they get tested at oral examinations in their final year.

1. Drontal Plus - One-dose dewormer
2. Advantix - Kills and repels. Not to be used in Cats.
3. Kiltix collars - Long-acting specialist against ticks
4. Bayticol - Anti-tick dogwash
5. Negasunt - Anti-maggots.

1. Drontal Plus (synergistic febantel and pyrantel formulation with praziquantel). Broad spectrum against round, hook, whip and tapeworms, nematode larvae and (when given daily for 3 consecutive days) Giardia which is a zoonosis. Safe in puppies, pregnant and nursing bitches. Strategic deworming is 4x/year with one dose. It seems that puppies as young as 2 weeks old can be dewormed. Note that Giardia treatment needs 3 consecutive days instead of one dose. Puppy can be given at 2 weeks of age and 2-weekly till they are part of the strategic deworming 4X/year.

2. Advantix Spot On (synergistic imidacioprid 10% and permethrin 50%). Kills fleas/larvae, ticks, mosquitoes, lice, stable/biting flies. Repels ticks, mosquitoes, sand flies, stable/biting flies. Repellency (anti-feeding) means that the parasites do not bite or attach to the body on contact with the dog. Explain this to the owner who may see one or two ticks on the body after application. Remove all ticks.

Safe in puppies over 7 weeks old, pregnant and nursing bitches.

NOT FOR CATS (imidacioprid is safe for use in cats but it is permethrin that cannot be metabolised by cats. Therefore Advantix is contra-indicated in cats). Ensure that cats do not groom the dog's skin that have had been applied Advantix.

Do not apply earlier than 1 day after bath and do not bathe earlier than 2 days after application. This advice does not seem practical for Singapore dog owners who usually bathe their dogs more than 1X weekly). If Singapore's dogs are usually bathed >1x/week, application of Advantix every 2 weeks instead of 4 weeks is needed.

Advantix is said to have acaricidal and repellent efficacy against tick infestations (Rhipicephalus sanguineus and Ixodes ricinus for 4 weeks, and Dermacentor reticulatus for 3 weeks). It kills fleas within 1 day following treatment and prevents further flea infestations for 4 weeks and so can be used as part of a Flea Allergy Dermatitis (FAD) treatment in dogs. But it is NOT to be used for FAD in cats (due to the permethrin component being toxic in cats).

Apply in 3 or more spots along the back of the dog. 5 spots are better.

In heavily infested dogs, use Bayticol dog wash first, apply Advantix and also treat the environment to prevent reinfestation (vacuum, wash bedding, clean tiles, apply Bayticol at 1 ml per 1.5 litres of water to tiled/concrete areas, not grassy areas). Remove all ticks still attached to the dogs after the use of Bayticol dog wash.
3. Kiltix collars (2.25% flumethrin and 10% propoxur). Spectrum of activity is 6-7 months. Longest lasting tickicide. Works within 24 hours reaching even remote parts of the body like the tail of the dog. Flumethrin has some repellency efficacy. But not comparable to Advantix's repellency. So, cannot claim that ticks, if trying to attach to the treated dog, will die very soon.

Does not lose its properties when it is wet. But take off collar before bath or swimming frequently. Also, you cannot use Advantix with collar as the collar will be affected. I don't see much interest in Singapore compared to the spot-ons like Frontline being available freely in the pet shop and convenient to use. I may try Kiltix collars but they are rarely available and so inconvenient for Singaporean dog owners who are city dwellers.

4. Bayticol 6% emulsion. (flumethrin 6%). Used as dip, spray, wash, environmental treatment. Efficacy against tick (40ppm), flea, lice, mite (30ppm) and environmental control (40ppm).
Larvicidal effect, inhibits oviposition (check label claims).
Residual efficacy: 7 days after application of 30 ppm, 3 ppm are still present on the hair.
How do vets apply Bayticol 6% emulsion?  In heavily infested dogs, use this onto dog to kill ticks first. Pull out all dead attached ticks. Then give Advantix 24 hours later to dog as spot on for 5 spots. Goes home with Advantix to be given 2-weekly for 2 months. De-contaminate the environment.

In one example of 4 Siberian Huskies with heavy infestations of ticks. I got the dog's coat clipped. Then I inject 1.0 ml ivomectin SC. After 12 hours, I applied Frontline Plus spot on. The dogs were sent home. However on Day 3, the owner returned the dogs as they have "ticks". All ticks were still attached to the body but they were dead. My assistants plucked out the ticks. An anti-tick solution (e.g. Bayticol 6% or Carrington Dog Wash) may be too risky for these dogs since they have got ivomectin and Frontline Plus.

However, spot-ons should be applied 2-4 weekly. This may be costly when the owner has 4 big dogs. There was a reinfestation because the owner's workers had neglected to apply the spot-ons or check the 4 dogs in his factory. The pictures of the de-ticking of one Husky case are shown below:



De-ticking heavily infested dogs at Toa Payoh Vets
Salivation: Obviously, if the dog licks the wash before it is dry, the dog will salivate and the owner may not be happy. Salivation will also occur even when the wash is dried, as I have seen such cases. Owners are worried, although the literature in "Promeris" - a competitor's spot on product claims that there is no need to worry as the dog is not poisoned but is showing "hyper salivation". In practice, the vet or groomer has to care about the owner's worry after application of the wash. One smart groomer advised me that she gets the dog to wear an e-collar and she has no such problems after tick wash with the Carrington Dog Wash (another competitor). The amount used is 1 ml per 1.5 liters of water. Check the label.

5. Negasunt powder (coumaphos, propoxuf, sulfanilamide). Dust thinly on wounds cleaned from dirt, pus and tissue debris. Maggots will crawl out.

Protects wound against bacterial infection and infestation with fly larvae, kills flies and fly larvae (larvicidal, repellent, anti-bacterial, adhesive, dying, deodorant, scar tissue forming activities.

CONCLUSION. Indoor and outdoor dogs, use Drontal plus with Advantix, Kiltix, Negasunt and Bayticol when necessary against all ecto-parasites.

Bayticol - Heavily infested dogs. Wash dog to remove parasites. Then apply Advantix or Kiltix 24 hours later for prevention.
 
Advantix. Heavily infested dogs. Use Advantix and Kiltix 24 hours later. Next Advantix application should be 5 cm apart from the Kiltix collar as the latter is affected. Negasunt. Can be applied together with Kiltix if wounds are not too close to collar. Same as for Advantix spot-on area.

IN TOA PAYOH VETS DE-TICKING PROGRAM FOR HEAVILY INFESTED DOGS, we clip the dog's coat, apply Bayticol 6% emulsion wash. Then 24 hours later, we pluck out all ticks before sending the dog home with Advantix spots-on to be applied every 3 weekly. We check the dogs for tick-borne diseases.

P.S
Tick infested dogs can get sick with tick fever or other diseases and some do die. Owners wanting to de-tick their dogs, tel: 6254 3326, 9668-6469, e-mail judy@toapayohvets.com
for appointment.

The website with pictures are at:
http://www.bekindtopets.com/dogs/20100196ectoparasites_control_dogs_ToaPayohVets.htm

Sunday's interesting cases

Sunday, July 24, 2011
I showed to my assistant Min the importance of proper recording for blood samples being sent to the lab from the example on this Sunday. Some assistants and employees take a much longer time to understand the significance of advices and this is the biodiversity of the human species.

A new client brought in a dog called Ted. I was going to operate on another dog called Tedi. "If you don't write the reference number, but just Ted or Tedi in the blood collection bottles of two dogs, the Lab may make mistakes in giving you the results. To them, they think Ted and Tedi are the same dog.

From now on, I told Min that he has to let the associate vets check the names and reference number before submission. The responsibility will be the vets, not his.

Baytril oral to hamsters and rabbits

Baytril comes in 10% bottle. I taught my assistant how to dilute it for hamsters and small mammals.

1 ml Baytril + 4 ml water = 2.5%
0.01 ml/25g twice a day for dwarf hamsters.
0.2ml/kg twice a day for rabbits etc.