Usually the vet gives an injection and ear drops and antibiotics. But no cure. The owner is unhappy as the dog keeps on scratching and the ears become smelly and red.
CASE STUDY
Ears very painful, esp. painful for the last 4 weeks. The dog just scratched her ears to death.
The Maltese just could not stop scratching her two ears. So the busy lady consulted me. The ear canals were swollen and red and so I would not be able to scope the ear canals to see what's wrong.
In this case, I suspect some foreign bodies stuck deep inside the horizontal canal.
ADVICE 1
My treatment in such cases would be 2 steps.
1. Anti-inflammatory and antibiotics to control the itchiness and infections. The owner is asked to return 5 days later for ear irrigation.
2. Ear irrigation 5 days later (Sunday today). The dog was wary of her ears being touched. So, I advised sedation. The owner wanted to know whether no sedation would be possible. How badly infected were thears? Could she just apply the ear ointment? Could she see me irrigating the ears so that she would learn how to do it?
ADVICE 2
Option: Vertical ear canal resection for long-standing ear infections (over several months and years) but most Singapore owners are not keen on this option. However, this option must be told as it is another option to monthly cleaning of the ears.
EAR IRRIGATION
1. Sedation is best. The poor dog would be avoiding and turning her head if forced to be restrained to be irrigated in the ears. In the past, I had tried to do ear irrigation without sedation (to save the owner some money) but it was very painful and stressful to the dog.
COACHING LESSON FOR MY ASSISTANT
Sunday, August 14, 2011
Friday, August 12, 2011
540. Dad's favourite Chinese Crested 3 kg only
"She weighs only 3 kg. This is Dad's favourite dog," the young lady said to me solemnly and worriedly as I had advised anaesthesia to pluck the big thick turf of ear hairs, clip the nails short, clip paw hairs, de-matt a few areas and do dental scaling. The dog just would not permit her to do it and now had red skin in the paws, legs, ears. She also had lots of dry scales or dandruff.
"Will you be the one doing the surgery?" she asked. "Yes," I said. The key to success in anaesthesia is to give the minimal dosage. And the vet must be vigilant and has experienced assistants who know anaesthesia very well. In this case, I ensure that I was in charge of anaesthesia as well.
I gave 50% of the calculated dosage of domitor and ketamine IV. I asked my assistant Min to get an electronic calculator and coached him on how the dosage is calculated. I wrote down on the paper the calculations to teach him the basics.
At 10 kg, a young healthy dog will be OK with domitor 0.4 ml and ketamine 0.5 ml combined IV in one syringe as an IV general anaethesia.
But this is a thin Chinese crested, stressed out by skin itchiness over the years and not in top health as dandruff keeps peeling off her skin. I did not take a blood test this time as I deemed it not necessary from general physical examination and history. However, the anaesthesia must be lowest but effective. So, I gave 50% based on 3kg.
All went well. I gave the dog a sniff of isoflurane gas as she was getting up. A sniff of less than 60 seconds. I observed the eye white being prominent. This indicated Stage 4 as the eyeball had rolled down and into danger territory. So, the gas was switched off. Everything went well. The dosage was sufficient for around 30 minutes which included all grooming and dental scaling.
Just to be on the safe side, I gave the antidote - Antisedan. In less than 1 minute, the Chinese Crested stood up and looked as fine. Pooped green stools. Went home in the afternoon after ear irrigation and a bath as the father and daughter came to pick her up and the Miniature Schnauzer (9 years old with similar requirements but had 7 loose teeth extracted). Also 50% dosage based on weight. And antisedan.
"No steroids," the young lady said. In this case, I have prescribed Atopica for 2 months plus the young lady's own special oil application to the skin as she had done successfully for the other Chinese Crested (hairless). Otherwise the Chinese crested keeps scratching herself day in and day out.
"Will you be the one doing the surgery?" she asked. "Yes," I said. The key to success in anaesthesia is to give the minimal dosage. And the vet must be vigilant and has experienced assistants who know anaesthesia very well. In this case, I ensure that I was in charge of anaesthesia as well.
I gave 50% of the calculated dosage of domitor and ketamine IV. I asked my assistant Min to get an electronic calculator and coached him on how the dosage is calculated. I wrote down on the paper the calculations to teach him the basics.
At 10 kg, a young healthy dog will be OK with domitor 0.4 ml and ketamine 0.5 ml combined IV in one syringe as an IV general anaethesia.
But this is a thin Chinese crested, stressed out by skin itchiness over the years and not in top health as dandruff keeps peeling off her skin. I did not take a blood test this time as I deemed it not necessary from general physical examination and history. However, the anaesthesia must be lowest but effective. So, I gave 50% based on 3kg.
All went well. I gave the dog a sniff of isoflurane gas as she was getting up. A sniff of less than 60 seconds. I observed the eye white being prominent. This indicated Stage 4 as the eyeball had rolled down and into danger territory. So, the gas was switched off. Everything went well. The dosage was sufficient for around 30 minutes which included all grooming and dental scaling.
Just to be on the safe side, I gave the antidote - Antisedan. In less than 1 minute, the Chinese Crested stood up and looked as fine. Pooped green stools. Went home in the afternoon after ear irrigation and a bath as the father and daughter came to pick her up and the Miniature Schnauzer (9 years old with similar requirements but had 7 loose teeth extracted). Also 50% dosage based on weight. And antisedan.
"No steroids," the young lady said. In this case, I have prescribed Atopica for 2 months plus the young lady's own special oil application to the skin as she had done successfully for the other Chinese Crested (hairless). Otherwise the Chinese crested keeps scratching herself day in and day out.
538. Z-plasty for a Syrian hamster?
This Syrian hamster was bitten through the vertical grate which separated two hamsters. A rotten-flesh smell leaked from a big black abscess on the left elbow. The abscess was drained by Vet 1 and the wound stitched up.
Two days later, the hamster came back as the stitches had broken down.
MY COMMENTS
1. Contaminated wounds are best not stitched. Give the hamster antibiotics for 3-7 days to get rid of the bacteria and to let the skin return to normal.
2. In this hamster, stitching the lower end to the upper end of the big wound will not permit healing as there is a high skin tension. This will lead to stitch breakdown.
3. Z-plasty and stitching up small areas in front of the elbow is one option.
4. I advised surgery but the owner did not accept. The chances of full cover of the skin wound are not 100% and the owner must be informed properly.
In dog bite wounds around this elbow, Z-plasty ought to be done as such big exposed areas are easily infected and itchy. It takes more than 3 months and does not heal as can be seen in one case handled by Vet 1 and observed by me earlier. In this case, the owner did not give permission for surgery and prefer simple nursing and treatment and that is where the vet's hands are tied.
It is not wise to keep such dogs for over 3 months inside the veterinary surgery to do simple nursing and treatment if owners do not want to permit surgery because keeping a dog hospitalised for such a long time is not good for the poor dog. The owner has to bear the responsibility of caring for the dog.
5. As for this Syrian hamster, I don't know what happen as the owner did not return for follow up. I prescribed antibiotics and anti-inflammatory oral and advised daily cleaning of the wound. I will be most surprised if this hamster survived the bacterial infection from the environment. But miracles do happen and the wound may close by granulation.
MORE DETAILS AND A DOG Z-PLASTY CASE IS AT:
http://www.sinpets.com/hamsters/201108012syrian-hamster-z-plasty-surgery-advised_singapore_ToaPayohVets.htm
Two days later, the hamster came back as the stitches had broken down.
MY COMMENTS
1. Contaminated wounds are best not stitched. Give the hamster antibiotics for 3-7 days to get rid of the bacteria and to let the skin return to normal.
2. In this hamster, stitching the lower end to the upper end of the big wound will not permit healing as there is a high skin tension. This will lead to stitch breakdown.
3. Z-plasty and stitching up small areas in front of the elbow is one option.
4. I advised surgery but the owner did not accept. The chances of full cover of the skin wound are not 100% and the owner must be informed properly.
In dog bite wounds around this elbow, Z-plasty ought to be done as such big exposed areas are easily infected and itchy. It takes more than 3 months and does not heal as can be seen in one case handled by Vet 1 and observed by me earlier. In this case, the owner did not give permission for surgery and prefer simple nursing and treatment and that is where the vet's hands are tied.
It is not wise to keep such dogs for over 3 months inside the veterinary surgery to do simple nursing and treatment if owners do not want to permit surgery because keeping a dog hospitalised for such a long time is not good for the poor dog. The owner has to bear the responsibility of caring for the dog.
5. As for this Syrian hamster, I don't know what happen as the owner did not return for follow up. I prescribed antibiotics and anti-inflammatory oral and advised daily cleaning of the wound. I will be most surprised if this hamster survived the bacterial infection from the environment. But miracles do happen and the wound may close by granulation.
MORE DETAILS AND A DOG Z-PLASTY CASE IS AT:
http://www.sinpets.com/hamsters/201108012syrian-hamster-z-plasty-surgery-advised_singapore_ToaPayohVets.htm
537. Follow-up on the cat having urination difficulty - FLUTD again
I spoke to your husband and fax copies of blood and urine test results to him yesterday.
1. Significant finding of the blood test is the low platelet count and the high glucose level. The low platelet count is probably due to the cat ingesting some toxic chemicals via grooming his coat. There was some "fur vomited" too. Abdominal pain was present.
2. For the urine test, there are bacteria, epithelial cells, white cells and red blood cells and a trace of protein present. This indicated a urinary tract infection involving primarily the bladder. A trace of protein may not be serious at this stage.
3. There is no kidney disease based on the blood and urine tests. No urinary crystals are detected. As for the high glucose level, a 2nd test is needed in 2 months' time to assess whether he has diabetes.
4. A test 2 months later is advised.
5 Advice: Keep the cat indoors and away from eating grass and soil. He has lost weight and this may be due to the ingestion of toxic chemicals tainting his coat and paws when he plays in the garden outdoors. Toxic chemicals may include insecticide and fertilisers and mosquito fogging chemicals. Some cats love to nap under the car, staining themselves with engine oil etc. So, it is best to keep this cat indoors all the time.
1. Significant finding of the blood test is the low platelet count and the high glucose level. The low platelet count is probably due to the cat ingesting some toxic chemicals via grooming his coat. There was some "fur vomited" too. Abdominal pain was present.
2. For the urine test, there are bacteria, epithelial cells, white cells and red blood cells and a trace of protein present. This indicated a urinary tract infection involving primarily the bladder. A trace of protein may not be serious at this stage.
3. There is no kidney disease based on the blood and urine tests. No urinary crystals are detected. As for the high glucose level, a 2nd test is needed in 2 months' time to assess whether he has diabetes.
4. A test 2 months later is advised.
5 Advice: Keep the cat indoors and away from eating grass and soil. He has lost weight and this may be due to the ingestion of toxic chemicals tainting his coat and paws when he plays in the garden outdoors. Toxic chemicals may include insecticide and fertilisers and mosquito fogging chemicals. Some cats love to nap under the car, staining themselves with engine oil etc. So, it is best to keep this cat indoors all the time.
Thursday, August 11, 2011
536. Text-message from a FLUTD cat owner
Yesterday, August 10, 2011, I met the FLUTD cat owner, a knowledgeable lady in her 30s. She had texted the following message to me the day before.
August 9, 2011 6.02 pm
Hi Dr Sing
TOMMY'S NOT PEEING AGAIN?!
It's been a few months since I updated you about Tommy. He was doing fine up till 2 days ago. Straining to pee and now vomiting after straining. Some fur in his vomit too. Very limtied appetite too, as if he's scared to eat lest he throws it up. I'll bring him to the clinic tomorrow morning. Hope you can see him and advise what's troubling him.
Happy National Day!
Names of husband and wife
I called her a knowledgeable lady as she had read all about FLUTD from the internet. She requested blood and urine tests, not just an injection and some antibiotics to go home. As vets, I would like to do the tests but some owners don't want to spend the money and so I try to give the basic treatment first and "wait-and-see" just to save the owner some money. This may not be a good way to practise veterinary medicine but Singapore owners go for the cheapest vet in town. All these tests add up to the costs and make me an "expensive" vet. However, to sophisticated and knowledgeable owners, failure to do tests indicate a vet not up to the mark! So, there must be a balance somewhere.
HISTORY-TAKING
"My cat can pee today!" the lady said.
"If your cat can pee," I replied. "There is no need to treat him."
Yet, on closer history-taking, the cat had difficulties peeing during the past 5 days, not 2 days.
"How do you know that your cat can pee normally?" I asked the lady.
"Well, he does it in front of me. He urinates a full stream of urine every morning in my presence."
An exhibitionist? I dared not say this loudly. Instead I asked when was the last time the cat could urinate without difficulty, namely a full stream of urine. It was 5 days ago, not 2 days as in her text message.
EXAMINATION
The significant finding was a painful abdomen and a weight loss of 1 kg compared to 2 months ago when I saw the cat (case report written, will get the URL). I could not palpate the left kidney. So, it would not be enlarged. His bladder was slightly full and contained some urine.
This is a 7-year-old male neutered cat that had FLUTD (feline lower urinary tract disease) some 2 months ago and had been on feline S/D diet for the past 2 months.
"Nobody tells me when I should stop the S/D diet. So two weeks ago, I had run out of S/D canned food and offered him ... (a commercial canned food).
"It is hard to say when the S/D canned food ought to be stopped. 2 months should be OK in some cases." I said. S/D is more expensive. This cat has been eating dry cat food over his past 7 years and just dislike canned food.
"Well, he has no choice, but to eat the S/D," the owner said when I asked her. The cat was losing weight.
"Could she be suffering from thyroid disease?" the owner asked me. This showed she had done her research in the internet. It is possible but the presenting sign is that of the urinary tract. So, I have to focus to check whether the cat has kidney disease or not first.
BLOOD TEST AND URINE TEST under sedation. I gave this 5kg cat xylazine 0.1 ml + ketamine 0.4 ml IM. With a few seconds whiff of isoflurane gas, he could be asleep with eyes open. The blood was collected from the big leg vein and his urine was collected from catherisation. About 20 ml of dark coloured thick urine. Claws were trimmed. No mouth ulcers or gingivitis. Pink tongue and mucous membranes. Some tartar on the teeth was scaled off.
After sedation injection, the cat vomited grass and dark yellow fluid (water and cat food likely, maybe some soil?). So the cat was not confined to inside the house as I presumed as he was supposed to me. He had access to the garden! To pee and be stressed out by neighbouring strays. This cat had lived in an apartment for the past 7 years till the shift to the parents' house temporarily. The cat had never seen other territorial cats before and now in this house, he met many. No wonder he was stressed out. He might be urine-marking too.
I will update readers soon as the case is being investigated. Like a detective story. Blood test and urine test results from the Lab will be in today.
August 9, 2011 6.02 pm
Hi Dr Sing
TOMMY'S NOT PEEING AGAIN?!
It's been a few months since I updated you about Tommy. He was doing fine up till 2 days ago. Straining to pee and now vomiting after straining. Some fur in his vomit too. Very limtied appetite too, as if he's scared to eat lest he throws it up. I'll bring him to the clinic tomorrow morning. Hope you can see him and advise what's troubling him.
Happy National Day!
Names of husband and wife
I called her a knowledgeable lady as she had read all about FLUTD from the internet. She requested blood and urine tests, not just an injection and some antibiotics to go home. As vets, I would like to do the tests but some owners don't want to spend the money and so I try to give the basic treatment first and "wait-and-see" just to save the owner some money. This may not be a good way to practise veterinary medicine but Singapore owners go for the cheapest vet in town. All these tests add up to the costs and make me an "expensive" vet. However, to sophisticated and knowledgeable owners, failure to do tests indicate a vet not up to the mark! So, there must be a balance somewhere.
HISTORY-TAKING
"My cat can pee today!" the lady said.
"If your cat can pee," I replied. "There is no need to treat him."
Yet, on closer history-taking, the cat had difficulties peeing during the past 5 days, not 2 days.
"How do you know that your cat can pee normally?" I asked the lady.
"Well, he does it in front of me. He urinates a full stream of urine every morning in my presence."
An exhibitionist? I dared not say this loudly. Instead I asked when was the last time the cat could urinate without difficulty, namely a full stream of urine. It was 5 days ago, not 2 days as in her text message.
EXAMINATION
The significant finding was a painful abdomen and a weight loss of 1 kg compared to 2 months ago when I saw the cat (case report written, will get the URL). I could not palpate the left kidney. So, it would not be enlarged. His bladder was slightly full and contained some urine.
This is a 7-year-old male neutered cat that had FLUTD (feline lower urinary tract disease) some 2 months ago and had been on feline S/D diet for the past 2 months.
"Nobody tells me when I should stop the S/D diet. So two weeks ago, I had run out of S/D canned food and offered him ... (a commercial canned food).
"It is hard to say when the S/D canned food ought to be stopped. 2 months should be OK in some cases." I said. S/D is more expensive. This cat has been eating dry cat food over his past 7 years and just dislike canned food.
"Well, he has no choice, but to eat the S/D," the owner said when I asked her. The cat was losing weight.
"Could she be suffering from thyroid disease?" the owner asked me. This showed she had done her research in the internet. It is possible but the presenting sign is that of the urinary tract. So, I have to focus to check whether the cat has kidney disease or not first.
BLOOD TEST AND URINE TEST under sedation. I gave this 5kg cat xylazine 0.1 ml + ketamine 0.4 ml IM. With a few seconds whiff of isoflurane gas, he could be asleep with eyes open. The blood was collected from the big leg vein and his urine was collected from catherisation. About 20 ml of dark coloured thick urine. Claws were trimmed. No mouth ulcers or gingivitis. Pink tongue and mucous membranes. Some tartar on the teeth was scaled off.
After sedation injection, the cat vomited grass and dark yellow fluid (water and cat food likely, maybe some soil?). So the cat was not confined to inside the house as I presumed as he was supposed to me. He had access to the garden! To pee and be stressed out by neighbouring strays. This cat had lived in an apartment for the past 7 years till the shift to the parents' house temporarily. The cat had never seen other territorial cats before and now in this house, he met many. No wonder he was stressed out. He might be urine-marking too.
I will update readers soon as the case is being investigated. Like a detective story. Blood test and urine test results from the Lab will be in today.
535. My three dwarf hamster patients - body odour, amputee, breast tumours
Today, August 11, 2011, I post my summary case report of my 3 dwarf hamster patients as I had written smaller case reports in the past weeks on the follow-up nursing care by the owners after surgeries.
The website for hamster lovers is:
http://www.sinpets.com/F5/20110733three-hamster-surgery-follow-up-Singapore-ToaPayohVets.htm
We all love happy endings. Owners who diligently observe their older hamsters for lumps and bumps will be less stressed out and save money if they get such lumps and bumps excised by their vets early. If their vet says: "Wait-and-see", then it is wise to seek a second and third opinion. In my experience, tumours don't disappear spontaneously. I did have a report from a hamster owner that the big tumour on her hamster (one of my hamster reports) disappeared after dieting or change of food. That was the feedback. In reality, tumours don't disappear and need to be excised early.
The website for hamster lovers is:
http://www.sinpets.com/F5/20110733three-hamster-surgery-follow-up-Singapore-ToaPayohVets.htm
We all love happy endings. Owners who diligently observe their older hamsters for lumps and bumps will be less stressed out and save money if they get such lumps and bumps excised by their vets early. If their vet says: "Wait-and-see", then it is wise to seek a second and third opinion. In my experience, tumours don't disappear spontaneously. I did have a report from a hamster owner that the big tumour on her hamster (one of my hamster reports) disappeared after dieting or change of food. That was the feedback. In reality, tumours don't disappear and need to be excised early.
Wednesday, August 10, 2011
534. Sunday's interesting cases
Aug 7, 2011
Tea cup poodle 3 months had diarrhoea. Young couple fed it something new after purchase. Started to vomit and became comatose on Saturday despite treatment. On Sunday, I switched to IV dextrose saline. He stood up, looked OK. Later in the evening he passed away. Stick to what the seller advised. No new food. Stresses
Aug 9, 2011 National Day
Maltese could not stop scratching frequently for the past month. "Shampoos, I used all types. What's the best?"
July 31, 2011
My assistant Min got his right thumb bitten by an old cat with kidney disease. He was transferring the cat out of the cage. As Dr Vanessa and I did not see him doing it, we were puzzled as to why the old cat sunk its canine deep into his right thumb. Dr Vanessa took him to a doctor. He said: "No need". But it is important as cat bites can be infectious.
He went and got 3 stitches to stop the bleeding.
Tea cup poodle 3 months had diarrhoea. Young couple fed it something new after purchase. Started to vomit and became comatose on Saturday despite treatment. On Sunday, I switched to IV dextrose saline. He stood up, looked OK. Later in the evening he passed away. Stick to what the seller advised. No new food. Stresses
Aug 9, 2011 National Day
Maltese could not stop scratching frequently for the past month. "Shampoos, I used all types. What's the best?"
July 31, 2011
My assistant Min got his right thumb bitten by an old cat with kidney disease. He was transferring the cat out of the cage. As Dr Vanessa and I did not see him doing it, we were puzzled as to why the old cat sunk its canine deep into his right thumb. Dr Vanessa took him to a doctor. He said: "No need". But it is important as cat bites can be infectious.
He went and got 3 stitches to stop the bleeding.
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