On Wed, Sep 14, 2011 at 12:07 PM, ...> wrote:
Hi
I have 13 cats and some of them have come down with flu like symptoms. The first cat who displayed the symptom,recovered within a few days, however, 3 of them seem more sick and are coughing too.
Please let me know if the vet can do a house call to examine all my cats as I’d rather not stress them further by taking them to the clinic.
Would like to know the charges please. Thank you.
Sincerely
E-MAIL REPLY DATED SEP 15, 2011
Pl provide a phone number for the vet to contact you to know more about the management of the cats and to discuss further.
Thursday, September 15, 2011
609. Signs of sickness in a hamster - email query
E-MAIL REPLY TO DR SING DATED SEP 15, 2011 2.12 AM
Good evening to whom may concern.
Im currently taking care of 2 lovely hamsters. And they are 1yr 6mths old and 1 of them is a white face roboroki and another is a normal roboroki. I have a emergency question to ask you. Recently my white face roboroki doesnt seem like himself. He dont want to eat and moving very slowly and his very WEAK. His eyes are like half open. And he keep on sleeping. He use to be a very active hamster. Is he sick? Please advise! Im very worry about him. Please help!!!
Regards,
Name & tel number
E-MAIL REPLY FROM DR SING DATED SEP 15, 2011 3.29 AM
I am Dr Sing from Toa Payoh Vets. Thank you for your email. Your hamster is sick. Please bring him to your vet for treatment urgently.
Good evening to whom may concern.
Im currently taking care of 2 lovely hamsters. And they are 1yr 6mths old and 1 of them is a white face roboroki and another is a normal roboroki. I have a emergency question to ask you. Recently my white face roboroki doesnt seem like himself. He dont want to eat and moving very slowly and his very WEAK. His eyes are like half open. And he keep on sleeping. He use to be a very active hamster. Is he sick? Please advise! Im very worry about him. Please help!!!
Regards,
Name & tel number
E-MAIL REPLY FROM DR SING DATED SEP 15, 2011 3.29 AM
I am Dr Sing from Toa Payoh Vets. Thank you for your email. Your hamster is sick. Please bring him to your vet for treatment urgently.
Wednesday, September 14, 2011
Taxidermy services in Singapore.
Rarely available in Singapore. There is one. Demand is extremely low. It is hard for me to assess the quality of taxidermy since the demand is very low. A chihuahua was sent but the owner complained about not up to her expectations.
607. Cremation of pets
FOR THE INFORMATION OF TOA PAYOH VETS' PET OWNERS
I spoke to the cremation man today regarding the cremation process which is similar to that in human cremation at crematoriums.
1. A common misconception is that cremation results in ashes. The output is 3-5% of the bodyweight, mainly bones in pieces. Skulls and big bones do remain. In hamsters, the bones still are present too.
2. For common cremation, the pets are placed in slots separated from one another by a partition. The ashes and bones are from each individual and not mixed.
3. For private individual creamtion with ashes in the urn, the fees are higher.
4. For owners of medium to large canine breeds, it will need a very big urn to store the skull and big bones. This is not the practice. Therefore, the bones in medium to big breeds are crushed by a machine to become ashes which can then be put into the small urn for the owner. For small breeds, bones may be present amongst the ashes.
5. Cremation is done by Singapore government-approved companies.
I spoke to the cremation man today regarding the cremation process which is similar to that in human cremation at crematoriums.
1. A common misconception is that cremation results in ashes. The output is 3-5% of the bodyweight, mainly bones in pieces. Skulls and big bones do remain. In hamsters, the bones still are present too.
2. For common cremation, the pets are placed in slots separated from one another by a partition. The ashes and bones are from each individual and not mixed.
3. For private individual creamtion with ashes in the urn, the fees are higher.
4. For owners of medium to large canine breeds, it will need a very big urn to store the skull and big bones. This is not the practice. Therefore, the bones in medium to big breeds are crushed by a machine to become ashes which can then be put into the small urn for the owner. For small breeds, bones may be present amongst the ashes.
5. Cremation is done by Singapore government-approved companies.
Still bad breath after dental scaling and extraction of 6 teeth in old small breed dog
Monday Sep 14, 2011
"Why my dog still has bad breath after dental scaling and extraction of 6 teeth?" the lady owner phoned me. She wanted the cause as the dog was done one month ago by Vet 1. She wanted a second opinion by phone.
"It is hard to tell you the cause," I said. "It will be best to examine the dog again."
She brought the dog to me yesterday. "After scaling and extraction, there was less bad breath but now it is bad. What is the cause?"
I asked Mr Goh, a man who came to sell me a new electro-surgical handle to wait. I don't know how the existing handle had lost its protective cover after electro-surgery and I told my assistant that he had to be responsible. He could not give an explanation of how it became lost after electro-surgery done by another vet.
Normally, I take great care of such tools and ensure that the set is accounted for and properly kept. But I did not perform that electro-surgery and that was when the holder cover was lost. It cost me $280 to replace the whole set.
This was a new client who wanted me to give a second opinion. I said: "It is best that I don't just state the possible causes. It is best to practise evidence-based medicine. By that I mean blood tests and a proper examination of the whole mouth for starters. This will require sedation as your dog does not permit mouth opening."
The owner had spent some $260 and said: "The pet shop operator scaled his teeth. I spent money on that. Now, Vet 1 charged me over $200. He is more expensive than (a brand-name vet practice) as that practice charges $10/tooth extracted.
I perused her bill and said: "Vet 1 also charged $10/tooth extracted. $30 for post-dental antibiotics and painkillers. $200 for anaesthetic and dental scaling. The charges are within market rate or lower."
I had the dog weighed and temperature taken. The dog was in good condition. I opened the mouth. The tongue and gums were normal. A bit of tartar and gingivitis. By the 3rd time I opened the mouth, the dog was growling as I tried to view the tonsils.
I put my nose close to the dog's open mouth. The dog exhaled. "Yes, the breath is very smelly." This procedure is actually not good for the vet as bacteria can get into a vet's throat and lungs. But smell is part of practice. The dog did not have such an offensive smell that the small consultation room stank as in some other dogs. Well, he did have dental scaling and 6 teeth extracted and would not be having very bad breath.
"Did Vet 1 do a blood test done before dental work?" I asked.
"He said blood test was not necessary."
"In old dogs, blood tests before surgery is necessary to know the health of the dog before doing anaesthesia. To assess whether the dog will be in danger during anaesthesia and die on the op table. But to save the owner's cost, Vet 1 did not advise it."
I asked: "Did Vet 1 give antibiotics after dental work?"
She said: "Vet 1 said it was not necessary as he had given one injection."
"Each vet has his own judgment as to the management of the case," I advised a blood test to rule out bad kidneys and other poor health as well as bacterial infections or poor immune system. Practising evidence-based medicine is preferred to wild speculations of the causes of bad breath.
"I know Vanessa," the owner had met Dr Vanessa some years ago.
I asked Dr Vanessa to come out from the backroom and both party had a joyous meeting.
"I will ask Dr Vanessa to handle your case," I withdrew from the case. Before I left, I told Dr Vanessa as to what I had said to the owner in the owner's presence to prevent misunderstanding.
I said: "I have advised a blood test and sedation and anaesthesia to examine the mouth properly. The causes can be tonsillar growths, tumours and ulcerations in the mouth and gums due to old age and other causes like uraemic gastritis (hence the blood test). Poor immune system and bacteraemia. So, this was not a simple case.
If anaesthesia is to be used, it is best to give just isoflurane gas. If conservative treatment is wanted, give appropriate antibiotics for 20-30 days.
The owner did not want any more sedation or anaesthesia for the old dog. I withdrew from the case but will follow up.
In conclusion, Vet 1 could have given a week's course of relevant antibiotics post-dental. This would be what I do in my handling of such cases. But each vet will handle a case differently and therefore much depends on the vet's judgment and the outcome. The interesting history from the owner was that this dog has less bad breath after dental work. The bad breath returned soon after. Why? It is like a Sherlock Holmes mystery that needs to be solved and I need to look for Dr Watson to help, assuming I play the role of Sherlock Holmes.
P.S.
How Mr Goh assess the activity of Toa Payoh Vets? He said he was impressed with my handling of this bad breath case. I don't know whether he was flattering me but we knew each other for over 20 years as he maintained my anaesthetic and medical equipment.
I was surprised when Mr Goh told me the following:
Mr Goh said to me: "Dr Vanessa is very busy nowadays. Every time I visit, she is doing some operations. There are some dogs inside the Surgery and clients outside the reception counter. When she first joined the practice, she was very free."
I said to Mr Goh matter of factly: "We have our quiet days but you are not around." It is possible that Dr Vanessa's clients had re-discovered her after she had left the other practice and so she became busier. There were also my existing clientele. Referrals add up to the caseload and are essential to any veterinary practice.
Mr Goh said: "There is a bad report about a vet in another practice according to the internet research my daughter has done. A dog died after operation and its owner wrote an adverse report about the practice. The owner wrote that when he phoned as to why the dog died, the vet said: "I don't know'. If the vet does not know, why is she a vet?"
I said: "This is where a blood test might be needed and be useful. Evidence-based medicine is important."
It is good to get feedback from outsiders like Mr Goh so as to improve the standard of practice. Younger vets are preferred to older vets as the Generation Y starts working and posseses buying powers. "Old vets are solid," one long-time industry veteran spoke to me once when I told him that there is what I think a trend to prefer younger vets since the new generation has grown up in an era of the internet and abundance. Old foggies should fade away into the sunset?
"Why my dog still has bad breath after dental scaling and extraction of 6 teeth?" the lady owner phoned me. She wanted the cause as the dog was done one month ago by Vet 1. She wanted a second opinion by phone.
"It is hard to tell you the cause," I said. "It will be best to examine the dog again."
She brought the dog to me yesterday. "After scaling and extraction, there was less bad breath but now it is bad. What is the cause?"
I asked Mr Goh, a man who came to sell me a new electro-surgical handle to wait. I don't know how the existing handle had lost its protective cover after electro-surgery and I told my assistant that he had to be responsible. He could not give an explanation of how it became lost after electro-surgery done by another vet.
Normally, I take great care of such tools and ensure that the set is accounted for and properly kept. But I did not perform that electro-surgery and that was when the holder cover was lost. It cost me $280 to replace the whole set.
This was a new client who wanted me to give a second opinion. I said: "It is best that I don't just state the possible causes. It is best to practise evidence-based medicine. By that I mean blood tests and a proper examination of the whole mouth for starters. This will require sedation as your dog does not permit mouth opening."
The owner had spent some $260 and said: "The pet shop operator scaled his teeth. I spent money on that. Now, Vet 1 charged me over $200. He is more expensive than (a brand-name vet practice) as that practice charges $10/tooth extracted.
I perused her bill and said: "Vet 1 also charged $10/tooth extracted. $30 for post-dental antibiotics and painkillers. $200 for anaesthetic and dental scaling. The charges are within market rate or lower."
I had the dog weighed and temperature taken. The dog was in good condition. I opened the mouth. The tongue and gums were normal. A bit of tartar and gingivitis. By the 3rd time I opened the mouth, the dog was growling as I tried to view the tonsils.
I put my nose close to the dog's open mouth. The dog exhaled. "Yes, the breath is very smelly." This procedure is actually not good for the vet as bacteria can get into a vet's throat and lungs. But smell is part of practice. The dog did not have such an offensive smell that the small consultation room stank as in some other dogs. Well, he did have dental scaling and 6 teeth extracted and would not be having very bad breath.
"Did Vet 1 do a blood test done before dental work?" I asked.
"He said blood test was not necessary."
"In old dogs, blood tests before surgery is necessary to know the health of the dog before doing anaesthesia. To assess whether the dog will be in danger during anaesthesia and die on the op table. But to save the owner's cost, Vet 1 did not advise it."
I asked: "Did Vet 1 give antibiotics after dental work?"
She said: "Vet 1 said it was not necessary as he had given one injection."
"Each vet has his own judgment as to the management of the case," I advised a blood test to rule out bad kidneys and other poor health as well as bacterial infections or poor immune system. Practising evidence-based medicine is preferred to wild speculations of the causes of bad breath.
"I know Vanessa," the owner had met Dr Vanessa some years ago.
I asked Dr Vanessa to come out from the backroom and both party had a joyous meeting.
"I will ask Dr Vanessa to handle your case," I withdrew from the case. Before I left, I told Dr Vanessa as to what I had said to the owner in the owner's presence to prevent misunderstanding.
I said: "I have advised a blood test and sedation and anaesthesia to examine the mouth properly. The causes can be tonsillar growths, tumours and ulcerations in the mouth and gums due to old age and other causes like uraemic gastritis (hence the blood test). Poor immune system and bacteraemia. So, this was not a simple case.
If anaesthesia is to be used, it is best to give just isoflurane gas. If conservative treatment is wanted, give appropriate antibiotics for 20-30 days.
The owner did not want any more sedation or anaesthesia for the old dog. I withdrew from the case but will follow up.
In conclusion, Vet 1 could have given a week's course of relevant antibiotics post-dental. This would be what I do in my handling of such cases. But each vet will handle a case differently and therefore much depends on the vet's judgment and the outcome. The interesting history from the owner was that this dog has less bad breath after dental work. The bad breath returned soon after. Why? It is like a Sherlock Holmes mystery that needs to be solved and I need to look for Dr Watson to help, assuming I play the role of Sherlock Holmes.
P.S.
How Mr Goh assess the activity of Toa Payoh Vets? He said he was impressed with my handling of this bad breath case. I don't know whether he was flattering me but we knew each other for over 20 years as he maintained my anaesthetic and medical equipment.
I was surprised when Mr Goh told me the following:
Mr Goh said to me: "Dr Vanessa is very busy nowadays. Every time I visit, she is doing some operations. There are some dogs inside the Surgery and clients outside the reception counter. When she first joined the practice, she was very free."
I said to Mr Goh matter of factly: "We have our quiet days but you are not around." It is possible that Dr Vanessa's clients had re-discovered her after she had left the other practice and so she became busier. There were also my existing clientele. Referrals add up to the caseload and are essential to any veterinary practice.
Mr Goh said: "There is a bad report about a vet in another practice according to the internet research my daughter has done. A dog died after operation and its owner wrote an adverse report about the practice. The owner wrote that when he phoned as to why the dog died, the vet said: "I don't know'. If the vet does not know, why is she a vet?"
I said: "This is where a blood test might be needed and be useful. Evidence-based medicine is important."
It is good to get feedback from outsiders like Mr Goh so as to improve the standard of practice. Younger vets are preferred to older vets as the Generation Y starts working and posseses buying powers. "Old vets are solid," one long-time industry veteran spoke to me once when I told him that there is what I think a trend to prefer younger vets since the new generation has grown up in an era of the internet and abundance. Old foggies should fade away into the sunset?
Tuesday, September 13, 2011
605. Anaesthesia - IV - ketamine + diazepam
DRAFT
TO BE REVISED AND MORE DETAILS TO BE CHECKED
METHOD 1
Healthy 10 kg dog
Premedicate with butomide 0.5mg/kg and ACP 0.2-0.4mg/kg IM. Wait 5 minutes.
Ketamine 0.5 ml + diazepam 0.5 ml = 1 ml in one syringe IV
Zoletil 100 top up if not intubated and connected to isoflurane gas. Give 0.05 - 0.1 ml IV via catheter drip set.
No need atropine
This process is claimed to be very safe for dogs and cats
CAT SPAY 4 kg
Ketamine 0.2 ml + diazepam 0.2 ml IV
compared to Ketamine 0.3 ml + xylazine 0.1 ml IM
METHOD 2
XYLAZINE+KETAMINE+ZOLETIL COMBINATION
Most economical for spaying and neutering stray dogs and cats.
No need premedication
Zoletil 100 is fast acting and safe
Zoletil top up by IM in 0.1 ml doses.
Quick surgery is needed. Must completed within 15 minutes if not topping up.
METHOD 3
XYLAZINE+KETAMINE
I use Ketamine 0.4 ml + xylazine 0.1 ml IM and find it most satisfactory and safe in cat spays which normally does not exceed 15 minutes. No need top up.
For cats over 8kg, Ketamine 0.8 ml + xylazine 0.2 ml IM.
METHOD 4
DOMITOR + KETAMINE
Heart rate goes down, very soft and sometimes the dog stops breathing, according to one vet. He said atropine maintains blood pressure. Advantage: Antisedan can reverse and dog wakes up fast and standing (within 5 minutes in my observation of younger dogs, within 15 minutes according to one report). A 12-year-old Alsatian took more than 30 minutes to stand up. (ear irrigation.)
METHOD 5
DOMITOR
Good for short surgical procedures less than 15 minutes. Sedation.
No premed. Antisedan reversal advantage.
According to one vet, the auricle and ventricle do not contract at the same time. Heart rate goes down, very soft and sometimes the dog stops breathing, according to one vet.
METHOD 6
PROPOFOL
10 KG - 5 ml
Give 3 ml first. If not sedated, 1 ml, then 1 ml. Intubate. Isoflurane gas. If moving, Zoletil top up. Quite unreliable analgesia. Will not recommend this method.
Use the small bottle as it cannot be kept long.
METHOD 7
ALPHAXON IV, INTUBATE + ISOFURANE GAS
For Caesarean section. Fast and effective. Does not kill pups.
GUINEA PIG
Domitor + Ketamine 0.25 + 0.15 ml SC. To check on this.
Each vet has his own favourite combination.
ZOLETIL
Said to be very safe.
Needs atropine 0.05 ml/kg before Zoletil
We always pre-med the animals followed by induction. In older or high risk patients use lower ACEPROMAZINE dose or leave out altogether.
MEDETOMIDINE doses recommended are actually lower than those suggested by manufacturer.
*ranges are given here depending to the temperament and amount of pain during the procedure.
WEIGHT OF ANIMAL IMPT!
(Acepromazine ranges 0.02-0.05 mg/kg - if very nervous give high dose. Opiod doses/type based on amount of pain control required - morphine/methadone for painful procedures, butorphanol/buprenorphine for less painful procedures requiring more sedative effects)
Pre-med (usually 45min - 1hr before induction)
DOGS
ROUTE - IM/SC
1. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Morphine 0.2-0.4 mg/kg
Do not use if vomiting, or if mass cell tumour (causes degranulation)
2. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Methadone 0.2-0.4 mg/kg
3. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Butorphanol 0.2-0.4 mg/kg
Sedation w/o analgesia, GOOD for echocardiography/chest rads/U/s
4. Medetomidine 3-5 mcg/kg + butorphanol 0.2-0.4 mg/kg +/- acepromazine 0.02 mg/kg
Reverse with same volume of atipamezole (anti-sedan)
5. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Buprenorphine 0.01-0.015 mg/kg
ROUTE - IV
1. Medetomidine 1 mcg/kg + butorphanol 0.1-0.2 mg/kg
CATS
ROUTE - IM/SC
1. Acepromazine 0.02-0.05 mg/kg + morphine/methadone 0.2-0.3 mg/kg then if not enough + 3-5 mg/kg ketamine
2. Acepromazine 0.02-0.04 mg/kg + Butorphanol 0.2-0.4 mg/kg +/- gas down with sevoflurane OR Alfaxalone/Propofol to effect
GOOD for echocardiography/chest rads/U/s
3.Medetomidine 10-40 mcg/kg + butorphanol 0.1-0.4 mg/kg (or morphine 0.3 mg/kg or buprenorphine 0.01-0.02 mg/kg)
*cats more refractory to medetomidine compared to dogs - may require 10-20 mcg/kg up to 80 mcg/kg (enough for castration)
Induction:
1. Alfaxalone (10mg/ml) -
1mg/kg IV dogs / cat IV (2mg/kg)
stable CV effects (but dose dependent)
fast knockdown, need to intubate quickly, transit to gas
never use halothane
more dysphoric on recovery
2. Valium/Ketamine
1ml/10kg IV of 50:50 volume mix cats and dogs
ketamine makes them tachycardic due to SNS stimulation
avoid in cardiac, renal, CNS disease
ketamine causes excess salivation
3. Propofol (10mg/ml)
2-4 mg/kg IV dogs and cats if has been premeded
6 mg/kg IV dogs and cats if has NOT been premeded
cats need up to 10-12 mg/kg IV
best if high risk patients
use to effect - can top-up if waking up
no excitement
GIVE SLOWLY otherwise too depressant on bp (CAN CAUSE APNOEA IF GIVEN TOO FAST)
watch breathing, is sedative
good for bains/spines, kidney and liver disease
contraindicated in pancreatitis
CVS effects are dose/rate dependant
*ALFAXALONE AND PROPOFOL HAVE TO BE TITRATED TO EFFECT AND GIVEN EXTREMELY SLOWLY TO AVOID POST INDUCTION APNOEA!! WATCH FOR BREATHING AFTER INDUCTION.
Maintenance
1. Inhalants anaesthetic (isoflurane etc to effect)
Hope this helps. As with the other regimes you have below, I can tell you the effect of the drugs but i cant tell you the appropriate dose rates required. Usually the choice of drugs are dependent on the procedure and the amount of sedation and pain management needed. Pre-med gives a smoother induction, easier placement of catheter etc.
TO BE REVISED AND MORE DETAILS TO BE CHECKED
METHOD 1
Healthy 10 kg dog
Premedicate with butomide 0.5mg/kg and ACP 0.2-0.4mg/kg IM. Wait 5 minutes.
Ketamine 0.5 ml + diazepam 0.5 ml = 1 ml in one syringe IV
Zoletil 100 top up if not intubated and connected to isoflurane gas. Give 0.05 - 0.1 ml IV via catheter drip set.
No need atropine
This process is claimed to be very safe for dogs and cats
CAT SPAY 4 kg
Ketamine 0.2 ml + diazepam 0.2 ml IV
compared to Ketamine 0.3 ml + xylazine 0.1 ml IM
METHOD 2
XYLAZINE+KETAMINE+ZOLETIL COMBINATION
Most economical for spaying and neutering stray dogs and cats.
No need premedication
Zoletil 100 is fast acting and safe
Zoletil top up by IM in 0.1 ml doses.
Quick surgery is needed. Must completed within 15 minutes if not topping up.
METHOD 3
XYLAZINE+KETAMINE
I use Ketamine 0.4 ml + xylazine 0.1 ml IM and find it most satisfactory and safe in cat spays which normally does not exceed 15 minutes. No need top up.
For cats over 8kg, Ketamine 0.8 ml + xylazine 0.2 ml IM.
METHOD 4
DOMITOR + KETAMINE
Heart rate goes down, very soft and sometimes the dog stops breathing, according to one vet. He said atropine maintains blood pressure. Advantage: Antisedan can reverse and dog wakes up fast and standing (within 5 minutes in my observation of younger dogs, within 15 minutes according to one report). A 12-year-old Alsatian took more than 30 minutes to stand up. (ear irrigation.)
METHOD 5
DOMITOR
Good for short surgical procedures less than 15 minutes. Sedation.
No premed. Antisedan reversal advantage.
According to one vet, the auricle and ventricle do not contract at the same time. Heart rate goes down, very soft and sometimes the dog stops breathing, according to one vet.
METHOD 6
PROPOFOL
10 KG - 5 ml
Give 3 ml first. If not sedated, 1 ml, then 1 ml. Intubate. Isoflurane gas. If moving, Zoletil top up. Quite unreliable analgesia. Will not recommend this method.
Use the small bottle as it cannot be kept long.
METHOD 7
ALPHAXON IV, INTUBATE + ISOFURANE GAS
For Caesarean section. Fast and effective. Does not kill pups.
GUINEA PIG
Domitor + Ketamine 0.25 + 0.15 ml SC. To check on this.
Each vet has his own favourite combination.
ZOLETIL
Said to be very safe.
Needs atropine 0.05 ml/kg before Zoletil
We always pre-med the animals followed by induction. In older or high risk patients use lower ACEPROMAZINE dose or leave out altogether.
MEDETOMIDINE doses recommended are actually lower than those suggested by manufacturer.
*ranges are given here depending to the temperament and amount of pain during the procedure.
WEIGHT OF ANIMAL IMPT!
(Acepromazine ranges 0.02-0.05 mg/kg - if very nervous give high dose. Opiod doses/type based on amount of pain control required - morphine/methadone for painful procedures, butorphanol/buprenorphine for less painful procedures requiring more sedative effects)
Pre-med (usually 45min - 1hr before induction)
DOGS
ROUTE - IM/SC
1. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Morphine 0.2-0.4 mg/kg
Do not use if vomiting, or if mass cell tumour (causes degranulation)
2. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Methadone 0.2-0.4 mg/kg
3. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Butorphanol 0.2-0.4 mg/kg
Sedation w/o analgesia, GOOD for echocardiography/chest rads/U/s
4. Medetomidine 3-5 mcg/kg + butorphanol 0.2-0.4 mg/kg +/- acepromazine 0.02 mg/kg
Reverse with same volume of atipamezole (anti-sedan)
5. Acepromazine 0.02-0.05 mg/kg up to 2mg TD(total dose) + Buprenorphine 0.01-0.015 mg/kg
ROUTE - IV
1. Medetomidine 1 mcg/kg + butorphanol 0.1-0.2 mg/kg
CATS
ROUTE - IM/SC
1. Acepromazine 0.02-0.05 mg/kg + morphine/methadone 0.2-0.3 mg/kg then if not enough + 3-5 mg/kg ketamine
2. Acepromazine 0.02-0.04 mg/kg + Butorphanol 0.2-0.4 mg/kg +/- gas down with sevoflurane OR Alfaxalone/Propofol to effect
GOOD for echocardiography/chest rads/U/s
3.Medetomidine 10-40 mcg/kg + butorphanol 0.1-0.4 mg/kg (or morphine 0.3 mg/kg or buprenorphine 0.01-0.02 mg/kg)
*cats more refractory to medetomidine compared to dogs - may require 10-20 mcg/kg up to 80 mcg/kg (enough for castration)
Induction:
1. Alfaxalone (10mg/ml) -
1mg/kg IV dogs / cat IV (2mg/kg)
stable CV effects (but dose dependent)
fast knockdown, need to intubate quickly, transit to gas
never use halothane
more dysphoric on recovery
2. Valium/Ketamine
1ml/10kg IV of 50:50 volume mix cats and dogs
ketamine makes them tachycardic due to SNS stimulation
avoid in cardiac, renal, CNS disease
ketamine causes excess salivation
3. Propofol (10mg/ml)
2-4 mg/kg IV dogs and cats if has been premeded
6 mg/kg IV dogs and cats if has NOT been premeded
cats need up to 10-12 mg/kg IV
best if high risk patients
use to effect - can top-up if waking up
no excitement
GIVE SLOWLY otherwise too depressant on bp (CAN CAUSE APNOEA IF GIVEN TOO FAST)
watch breathing, is sedative
good for bains/spines, kidney and liver disease
contraindicated in pancreatitis
CVS effects are dose/rate dependant
*ALFAXALONE AND PROPOFOL HAVE TO BE TITRATED TO EFFECT AND GIVEN EXTREMELY SLOWLY TO AVOID POST INDUCTION APNOEA!! WATCH FOR BREATHING AFTER INDUCTION.
Maintenance
1. Inhalants anaesthetic (isoflurane etc to effect)
Hope this helps. As with the other regimes you have below, I can tell you the effect of the drugs but i cant tell you the appropriate dose rates required. Usually the choice of drugs are dependent on the procedure and the amount of sedation and pain management needed. Pre-med gives a smoother induction, easier placement of catheter etc.
SUNDAY'S INTERESTING CASE. Sep 11, 2011. Urine test shows bacteria 3+
When the urine is collected directly from a dog peeing outdoors, there is the possibility of bacterial contamination. In this case of one dog who had fits for the 3rd time 2 days ago, I reviewed the record of one urine sample collected and tested showing bacteria +++. However, no antibiotics was prescribed by Vet 1. Vet 1 received the urine sample and handled the case accordingly.
I know that the owner works in a human medical polyclinic and knows what to do when it comes to urine collection.
She collected the urine "mid-stream", that is, let the dog pass some urine first and then collect directly the next flow. The urine was collected in a container provided by the Lab. She sent the urine in to Toa Payoh Vets for analysis. As I was not around, Vet 1 took the responsibility of handling this urine sample.
The urine showed 3+.
Now, in veterinary medicine, each vet has his or her own interpretation of the laboratory results and come to a decision.
Vet 1 judged that the bacteria was not from the urine. Therefore no antibiotics were prescribed.
In my opinion, I would have prescribed antibiotics for a suspected urinary tract infection. A bacterial culture would have been advised too but due to financial considerations for the owners, this is often not asked of the owner.
I asked Vet 1 who said that the owner did not wish to have antibiotics.
The owner came on this Sunday to see her dog. I asked why she did not want antibiotics. She said: "Vet 1 said that no antibiotics were necessary as the urine was contaminated."
Now there was a difference of reply. I needed to investigate what happened, being the licensee and shouldering the responsibilities of sustaining a practice.
So, I had a meeting with Vet 1, the owner and myself present inside the consultation room to clarify the matter immediately, as to why the owner did not want antibiotics. There are some Singapore owners who don't want antibiotics nowadays and so Vet 1's explanation would be logical had I not asked the owner's side of the story. The vet on the spot has to judge. And be responsible for the judgment.
At the meeting on this busy Sunday morning, the owner denied having said she did not want antibiotics. "Why would I reject antibiotics when my cat's urine has bacteria 3+?" she protested.
Vet 1 said: "It is a mis-communication." It was an emotional meeting to clear the air as the owner was very upset over the allegations. A dog with three fits is a very stressful to any owner. The dog had a sudden attack, ran to her father screaming. Foam spilled out of the dog's mouth. When the dog was calmed down, the dog started pooping and peeing all over the apartment. She phoned me for a house-call but I told her it would be better to send the dog down for my examination. She had not told me of the 2nd fit episode.
I had a blood test, urine test, X-ray of the chest and abdomen done with permission from the owner. I reviewed the urine test result done some 3 weeks ago and noted that Vet 1 had not prescribed any antibiotics. Hence, the situation arose when I found this out.
A vet has to be responsible for his judgment. Sometimes, I do not prescribe antibiotics if I deem it unnecessary. In one case, I spayed a female dog and had given an antibiotic and pain-killer injection. As the spay was a smooth short surgery, I did not deem it necessary to give antibiotics and pain-killers at home. However, the owner's wife wanted the medication. The harassed husband came for them. It does not matter what I think. I prescribed the antibiotics and pain-killers for the next 4 days.
The husband came for the medication. He gave me a feedback, saying he wanted to bash Vet 1's up. "Why?" I asked. He said: "Vet 1 shouted at me from inside the consultation room when I asked a question how long the pain-killer injection lasted. Sitting on his chair and shouting from inside the room. So rude!"
I said: "From my knowledge of Vet 1 over the years, Vet 1 has a gentle personality."
Later, I asked Vet 1 what had happened. Vet 1 said that Vet 1 was busy consulting and therefore shouted out the reply.
Much could have been avoided had I prescribed antibiotics and pain-killers for 4 days after the operation as I usually do. You can say it was a lapse of judgment, but I find that dogs and cats who had one post-op injection of antibiotics and pain-killers do well.
Sometimes, it is best to prescribe antibiotics as it is hard to tell whether the infection will set in. In any case, a dog urine with bacteria +++ definitely requires antibiotics and failure to give them may constitute an act of negligence in a court of law if a "reasonable man" (i.e. a vet) will prescribe antibiotics in such a situation. Singapore owners are much more sophisticated. They will check the internet first to do research before consulting the vet.
In this case of the dog with the 2nd fit, the owner did not inform me about the incident till Sunday. As to the cause of the fit, most of the causes are idiopathic, ie. unknown.
However, based on the fact that the dog had urinary bladder stones removed and had fits after the surgery (first episode) a few months ago, there could be a relationship to urinary stone formation. In the 3rd episode, the dog had passed blood, blood was 4+, White cells very high, the pH was 8.0 (alkaline) and struvite crystals (2+) was detected in the urine.
The owner had fed rawhide as she felt that the dog's quality of life must be poor, eating SD diet every day. Would this be the cause of recurrence of urinary bladder crystals and high pH? It is hard to say. X-ray did not show any radio-opaque struvite stones.
More urine and other test need to be done monthly or 3-monthly. But few owners do bother. Till another episode of fits.
I know that the owner works in a human medical polyclinic and knows what to do when it comes to urine collection.
She collected the urine "mid-stream", that is, let the dog pass some urine first and then collect directly the next flow. The urine was collected in a container provided by the Lab. She sent the urine in to Toa Payoh Vets for analysis. As I was not around, Vet 1 took the responsibility of handling this urine sample.
The urine showed 3+.
Now, in veterinary medicine, each vet has his or her own interpretation of the laboratory results and come to a decision.
Vet 1 judged that the bacteria was not from the urine. Therefore no antibiotics were prescribed.
In my opinion, I would have prescribed antibiotics for a suspected urinary tract infection. A bacterial culture would have been advised too but due to financial considerations for the owners, this is often not asked of the owner.
I asked Vet 1 who said that the owner did not wish to have antibiotics.
The owner came on this Sunday to see her dog. I asked why she did not want antibiotics. She said: "Vet 1 said that no antibiotics were necessary as the urine was contaminated."
Now there was a difference of reply. I needed to investigate what happened, being the licensee and shouldering the responsibilities of sustaining a practice.
So, I had a meeting with Vet 1, the owner and myself present inside the consultation room to clarify the matter immediately, as to why the owner did not want antibiotics. There are some Singapore owners who don't want antibiotics nowadays and so Vet 1's explanation would be logical had I not asked the owner's side of the story. The vet on the spot has to judge. And be responsible for the judgment.
At the meeting on this busy Sunday morning, the owner denied having said she did not want antibiotics. "Why would I reject antibiotics when my cat's urine has bacteria 3+?" she protested.
Vet 1 said: "It is a mis-communication." It was an emotional meeting to clear the air as the owner was very upset over the allegations. A dog with three fits is a very stressful to any owner. The dog had a sudden attack, ran to her father screaming. Foam spilled out of the dog's mouth. When the dog was calmed down, the dog started pooping and peeing all over the apartment. She phoned me for a house-call but I told her it would be better to send the dog down for my examination. She had not told me of the 2nd fit episode.
I had a blood test, urine test, X-ray of the chest and abdomen done with permission from the owner. I reviewed the urine test result done some 3 weeks ago and noted that Vet 1 had not prescribed any antibiotics. Hence, the situation arose when I found this out.
A vet has to be responsible for his judgment. Sometimes, I do not prescribe antibiotics if I deem it unnecessary. In one case, I spayed a female dog and had given an antibiotic and pain-killer injection. As the spay was a smooth short surgery, I did not deem it necessary to give antibiotics and pain-killers at home. However, the owner's wife wanted the medication. The harassed husband came for them. It does not matter what I think. I prescribed the antibiotics and pain-killers for the next 4 days.
The husband came for the medication. He gave me a feedback, saying he wanted to bash Vet 1's up. "Why?" I asked. He said: "Vet 1 shouted at me from inside the consultation room when I asked a question how long the pain-killer injection lasted. Sitting on his chair and shouting from inside the room. So rude!"
I said: "From my knowledge of Vet 1 over the years, Vet 1 has a gentle personality."
Later, I asked Vet 1 what had happened. Vet 1 said that Vet 1 was busy consulting and therefore shouted out the reply.
Much could have been avoided had I prescribed antibiotics and pain-killers for 4 days after the operation as I usually do. You can say it was a lapse of judgment, but I find that dogs and cats who had one post-op injection of antibiotics and pain-killers do well.
Sometimes, it is best to prescribe antibiotics as it is hard to tell whether the infection will set in. In any case, a dog urine with bacteria +++ definitely requires antibiotics and failure to give them may constitute an act of negligence in a court of law if a "reasonable man" (i.e. a vet) will prescribe antibiotics in such a situation. Singapore owners are much more sophisticated. They will check the internet first to do research before consulting the vet.
In this case of the dog with the 2nd fit, the owner did not inform me about the incident till Sunday. As to the cause of the fit, most of the causes are idiopathic, ie. unknown.
However, based on the fact that the dog had urinary bladder stones removed and had fits after the surgery (first episode) a few months ago, there could be a relationship to urinary stone formation. In the 3rd episode, the dog had passed blood, blood was 4+, White cells very high, the pH was 8.0 (alkaline) and struvite crystals (2+) was detected in the urine.
The owner had fed rawhide as she felt that the dog's quality of life must be poor, eating SD diet every day. Would this be the cause of recurrence of urinary bladder crystals and high pH? It is hard to say. X-ray did not show any radio-opaque struvite stones.
More urine and other test need to be done monthly or 3-monthly. But few owners do bother. Till another episode of fits.
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