Although German Shepherd dogs have erect years, some do suffer from ear infections but most don't. I have a case where the dog keeps rubbing his infected years for several years. The condition becomes chronic otitis externa. The owner pours in ear drops, ear oil, ear powder and anything as can be purchased from the pet shop. But the condition does not improve because the owner had not got rid of the dirt, hairs and dead cells inside the horizontal ear canal. Vets have had been consulted but the problem persists. So the owner tried another vet.
What to do in such cases?
Ear irrigation under sedation by your vet and medication. Follow up in one month's time but few Singapore owners bother to do so.
Usually such dogs are old but they need not suffer if the owner gets a vet who treats the dog with ear irrigation and follow up rather than some injections, medications and ear drops. The following is an example of a case I treated.
GERMAN SHEPHERD, MALE, 11 YEARS, 37.2 kg
Right ear full of smell and blood. Scratching all the time.
The owner was in a hurry. "No quick solution," I said. "The ear canal needs to be irrigated thoroughly and that means the dog has to be sedated. There are anaesthetic risks involved."
SEDATION
The owner was aware of the risk. I gave the following.
37.2 KG
CALCULATED DOSAGE/10 KG HEALTHY YOUNG DOG IS:
Domitor 0.4 ml + Ketamine 0.5 ml IV = 0.9 ml IV
For 37 kg, the dosage should be 3.7X but not for old dogs.
FOR THIS DOG, 37.2 KG, OLD
Domitor 0.8 ml + Ketamine 1.4 ml IV = 2.2 ml IV
Good sedation.
Atropine 1.5 ml IM
Both ears were irrigated more than 30 times with 20-ml syringe with the dog in dorsal recumbency (on his chest).
After that I gave Antisedan 1.0 ml IV to reverse the effects of Domitor. The dog took 10 minutes to wake up but was very weak. We carried him to the owner's car. Medication, ear ointment. I doubt I will see him again. A follow up one month later will be necessary but almost 100% of the owners don't bother.
My brother had a German Shepherd with the same problem. Usually he consulted other vets for some reasons I did not ask. However, he would order Hills' anti-allergy dry dog food for this dog through my practice.
One day, I told him that his dog's chronic ear infections would be likely due to an infection and not just due to "dog food allergy". He brought his dog in for treatment of ear irrigation under sedation to flush out all debri and dead cells, some 5 months ago. I must ask what happened now as I did not see him recently and forgot to follow up. No news is good news?
Case 2. FOX TERRIER, MALE, 12 YEARS
The complaint is that the skin disease does not cure despite spending lots of money seeing the vets. The sides of the chest become bald. This was generalised ringworm. I advised clipping and gave medication for 20 days. I asked for review 4 weeks later. The owner did not turn up. The dog also had difficulty peeing and I detected an enlarged prostate and advised neuter if it is enlarged. The ear flaps were black due to continued scratching over the years of suffering.
2 months later, he turned up to say that the dog still has scales but the hairs had grown back on both sides of the chest. Ringworm was detected. The dog's ears were full of liquid sounds. The wife poured pet shop ear drops almost daily. No ear pain. Much improved ear flap in that the black colour was gone by 80%.
Reviews are necessary in skin diseases. Otherwise, the owner keeps vet hopping and spends a lot of money. Who to blame? But the vet! It is best to communicate repeatedly to the owner that not all skin diseases may not be cured with one visit. However, a vet who fails to perform (by producing a cure in one treatment) will lose the client and this has happened to me too. No second chances from some owners in private practice. Cure or no cure.
P.S. In xylazine + ketamine IV sedation, the guideline is less ketamine proportion for dogs. More ketamine proportion for cats. Does it apply to domitor + ketamine sedation? I need to do some research on this. In cats, I give xylazine 0.1 ml + ketamine 0.4 ml IM for less than 5 kg spay. I have not used the combination in dogs.
Thursday, September 22, 2011
623. Follow up on dwarf hamster with rotten-smelly right ear
PARTIAL REPORT
WILL SUMMARISE LATER
E-MAIL FROM OWNER DATED SEP 4, 2011 REGARDING RED AREA IN HAMSTER EAR ABOVE AND BEHIND THE RIGHT EYE
Thanks for the follow-up, Dr Sing.
On Sep 5, 2011, at 15:28, Kong Yuen Sing <99pups@gmail.com> wrote:
> Thanks for 2 pictures. There may be some growing internal abscess/cyst in the reddish area to the upper right quadrant of the ear canal opening. That is why the hamster is scratching it as in the previous time.
>
> See if the medication can work.
BACK TO THE BEGINNING, THE FIRST CONSULTATION PICTURE - Stinky smelly right ear complaint. A simple case of necrotic otitis externa? No.
Case recorded at:
http://www.sinpets.com/hamsters/20110808dwarf-hamster-break-a-leg-a-ear-Singapore-ToaPayohVets.htm
2ND CONSULTATION AND SURGERY - EAR CANAL ABLATION FOLLOW UP. RIGHT EAR WAS STILL ITCHY. IRRIGATE WOUND - MORE YELLOW PUS AND GRANULES FLUSHED OUT
3RD CONSULTATION AND SURGERY - BIG CYST AND TWO BIG ABSCESSES
Case recorded at:
http://www.sinpets.com/F6/20110906dwarf-hamster-cyst-abscesses-ear-canal-ablation-singapore_ToaPayohVets.htm
4TH CONSULTATION AND SURGERY - RIGHT UPPER QUADRANT SWOLLEN WITH PUS - TRACKED DOWNWARDS TO BEHIND THE MOUTH
LATEST STATUS AS AT SEP 22, 2011
http://www.sinpets.com/F6/20110906dwarf-hamster-cyst-abscesses-ear-canal-ablation-singapore_ToaPayohVets.htm
As at Sep 22, 2011, the hamster is recovering. Had passed loose stools. Stopped the vegetables. I have advised small amounts of mashed pelleted food and water, hand-feeding 10X/day as the hamster ate little and drank less. Continue the melon seeds. Very nervous when the owner handled her as well as when I did it prior to surgery. This was to be expected as she is in pain. Surprisingly, no major facial nerves appear to have been damaged by the large vertical incision to flush out the yellow purulent granules.
It is a long story. I hope readers can follow the four serials
WILL SUMMARISE LATER
E-MAIL FROM OWNER DATED SEP 4, 2011 REGARDING RED AREA IN HAMSTER EAR ABOVE AND BEHIND THE RIGHT EYE
Thanks for the follow-up, Dr Sing.
On Sep 5, 2011, at 15:28, Kong Yuen Sing <99pups@gmail.com> wrote:
> Thanks for 2 pictures. There may be some growing internal abscess/cyst in the reddish area to the upper right quadrant of the ear canal opening. That is why the hamster is scratching it as in the previous time.
>
> See if the medication can work.
BACK TO THE BEGINNING, THE FIRST CONSULTATION PICTURE - Stinky smelly right ear complaint. A simple case of necrotic otitis externa? No.
Case recorded at:
http://www.sinpets.com/hamsters/20110808dwarf-hamster-break-a-leg-a-ear-Singapore-ToaPayohVets.htm
2ND CONSULTATION AND SURGERY - EAR CANAL ABLATION FOLLOW UP. RIGHT EAR WAS STILL ITCHY. IRRIGATE WOUND - MORE YELLOW PUS AND GRANULES FLUSHED OUT
3RD CONSULTATION AND SURGERY - BIG CYST AND TWO BIG ABSCESSES
Case recorded at:
http://www.sinpets.com/F6/20110906dwarf-hamster-cyst-abscesses-ear-canal-ablation-singapore_ToaPayohVets.htm
4TH CONSULTATION AND SURGERY - RIGHT UPPER QUADRANT SWOLLEN WITH PUS - TRACKED DOWNWARDS TO BEHIND THE MOUTH
LATEST STATUS AS AT SEP 22, 2011
http://www.sinpets.com/F6/20110906dwarf-hamster-cyst-abscesses-ear-canal-ablation-singapore_ToaPayohVets.htm
As at Sep 22, 2011, the hamster is recovering. Had passed loose stools. Stopped the vegetables. I have advised small amounts of mashed pelleted food and water, hand-feeding 10X/day as the hamster ate little and drank less. Continue the melon seeds. Very nervous when the owner handled her as well as when I did it prior to surgery. This was to be expected as she is in pain. Surprisingly, no major facial nerves appear to have been damaged by the large vertical incision to flush out the yellow purulent granules.
It is a long story. I hope readers can follow the four serials
Wednesday, September 21, 2011
622. Dwarf hamster lost 3 g after 4th anaesthesia and surgery
The 2-year-old female hamster with the stinking right ear still had infection, this time, at another place. The lady owner had red eyes as I explained to her that the risks are higher everytime her dwarf hamster undergoes anaesthesia and surgery. I guessed she delayed as long as possible and now the hamster kept scratching her right ear tip. I noted that the tip was blackened. So, she came to me.
I gave isoflurane gas. Cut a big vertical cut and dug out all the yellowish granules of pus deep inside. I irrigated the holes as big as 1.5 cm and that is big if you are a hamster. The rotting smell (like bad breath) came back slightly. Now, the incision extended into the right cheek and into mouth.
The hamster was still alive 4 days after surgery when I phoned her.
"Not eating much," the owner said. "One melon seed and soft food."
"This is a tough cookie. She survived 4 anaesthesia though she is quite old. It must be very painful to eat. Can you weigh her? She had lost 3 g during surgery" I asked.
She had no appropriate small weighing machine. "You can count the number of faecal pellets," I said.
"My hamster is now having soft stools. Shall I stop the vegetables?" she asked.
"Yes," I said. "Otherwise we will get a serious 'wet tail' problem"
What to advise now?
"Feed her by syringe, a drop at a time," I advised. "10 times a day. For example, mash up the pellet and feed her. Give her water by syringe as she does not drink much. This will prevent dehydration. Hand feeding is very important for recovery. I had a case of a gentleman who nursed his severely dehydrated hamster back to health through feeding many times a day. I didn't expect him (as a man) to have the patience to do it but he proved me wrong."
I hope this hamster survives. As to what causes this evil smelling infection, it is hard to say since no bacterial culture has been done. The lower the vet cost, the better for the owner. There seemed to be a deep infection. It could be the inner ear but since hamsters are so small, no X-ray is practical unlike in dogs. The infection could be from the mouth to the Eustachian tube to the inner ear. Hard to verify. This is one of those unusual cases where the lady owner did not give up caring for a dwarf hamster. A new dwarf hamster costs around $15.00 if one is calculating and this is the way the older generation thinks.
I gave isoflurane gas. Cut a big vertical cut and dug out all the yellowish granules of pus deep inside. I irrigated the holes as big as 1.5 cm and that is big if you are a hamster. The rotting smell (like bad breath) came back slightly. Now, the incision extended into the right cheek and into mouth.
The hamster was still alive 4 days after surgery when I phoned her.
"Not eating much," the owner said. "One melon seed and soft food."
"This is a tough cookie. She survived 4 anaesthesia though she is quite old. It must be very painful to eat. Can you weigh her? She had lost 3 g during surgery" I asked.
She had no appropriate small weighing machine. "You can count the number of faecal pellets," I said.
"My hamster is now having soft stools. Shall I stop the vegetables?" she asked.
"Yes," I said. "Otherwise we will get a serious 'wet tail' problem"
What to advise now?
"Feed her by syringe, a drop at a time," I advised. "10 times a day. For example, mash up the pellet and feed her. Give her water by syringe as she does not drink much. This will prevent dehydration. Hand feeding is very important for recovery. I had a case of a gentleman who nursed his severely dehydrated hamster back to health through feeding many times a day. I didn't expect him (as a man) to have the patience to do it but he proved me wrong."
I hope this hamster survives. As to what causes this evil smelling infection, it is hard to say since no bacterial culture has been done. The lower the vet cost, the better for the owner. There seemed to be a deep infection. It could be the inner ear but since hamsters are so small, no X-ray is practical unlike in dogs. The infection could be from the mouth to the Eustachian tube to the inner ear. Hard to verify. This is one of those unusual cases where the lady owner did not give up caring for a dwarf hamster. A new dwarf hamster costs around $15.00 if one is calculating and this is the way the older generation thinks.
621. Health screening for your older dog - update
Health Screening For the Older Dogs
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date: 21 September, 2011 toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
Most pet owners in Singapore live hectic lives. There is just too many distractions and too much work.
After an intense care for their puppies, the senior dogs are just left alone as there is no time for them after their puppyhood. It is usually too late for many dogs when they are sent to the veterinarian for some chronic disease problems. Veterinary costs become high as the dog is in poor health and need more intensive care.
Senior dogs are:
Small and Medium-sized breeds: Over 7 years
Large and Giant-sized breeds: Over 5 years.
For those who may want their senior dogs to live longer, here are the following recommendations available at Toa Payoh Vets:
1. Veterinary examination every 6-12 months including examination for tumours and growths, ear infections, eye diseases, skin diseases
2. Blood tests to check for blood disorders, diabetes, liver and kidney diseases.
3. Urine tests to check on bladder and kidney infections and presence of urinary stones.
4. X-rays for arthritic hip joints (can't stand up easily), spinal column, heart and lungs.
5. Dental check up and scaling every year.
6. Heart check for murmurs and heart diseases.
7. Stool test for blood, parasites
8. A report and discussion about the delay in senility, obesity, behavioural problems, skin problems and any questions related to each individual dog. Tumours detected early can be excised saving the dog's life and reducing veterinary costs.
An example of the investigation tests and surgeries done for one older dog with heart disease and another with gum tumour is shown below
Case 1: Heart disease confirmed in an old companion
Cardiac Tamponade in a Labrador Retriever - Pt 1 Cardiac Tamponade in a Labrador Retriever - Pt 2
subcutaneous swelling - edema - cardiac tamponade - heart base tumour likely - toapayohvets, singapore Cardiac tamponade, 13 days after pericardiocentesis, lab retriever, toapayohvets, singapore Labrador Retriever, Male, 8 years, short of breath, transthoracic echocardiography, toapayohvets, singapore
labrador retriever, male, 8 years, skin swellings, cardiac tamponade, toapayohvets, singapore labrador retriever, male, 8 years, skin swellings, cardiac tamponade, toapayohvets, singapore Labrador Retriever, Male, 8 years, short of breath, transthoracic echocardiography, toapayohvets, singapore
Case 2: Get tumours excised by your vet when they are smaller
Large cancerous gum and hard palate tumour. Jack Russell, 10 years. Toa Payoh Vets Isoflurane Gas Anaesthesia. Electro-cutting removed gum tumour first. Note hard palate tumour. Toa Payoh Vets
Large cancerous gum and hard palate tumour. Jack Russell, 10 years. Toa Payoh Vets Large cancerous gum and hard palate tumour. Jack Russell, 10 years. Toa Payoh Vets
Electrosurgery stops profuse bleeding during gum & hard palate tumour removal. Toa Payoh Vets Gum and hard palate tumours in old dogs can be prevented with good dental hygiene and health. Toa Payoh Vets.
Large cancerous gum and hard palate tumou excised. Jack Russell, 10 years. Toa Payoh Vets Jack Russell, Gum & Hard Palate Tumour excised. Vet Intern. Toa Payoh Vets.
Old dogs are very high anaesthetic risks as they are seldom in the best of health unlike younger ones. Everyone is happy when the old dog does not die on the operating table after surgery. But every vet will have cases of old dogs dying on the operating table as it is impossible to get good clinical outcomes when the vets undertake high-risk16 years old fox terrier, not neutered, male, circum-anal, tail gland tumours, toapayohvets, singapore anaesthetics. This is one main reason why some vets discourage or reject old dog surgeries. "The old dog will pass away before the circum-anal tumours grow much bigger," one vet said to the owner. But the dog lived longer, splattering the apartment with blood from the bleeding tumour and requiring frequent cleaning up.
When a dog dies on the operating table, it is just too emotional for everyone including the operating veterinary surgeon. Such deaths may be bad-mouthed by the owner or the family members to friends and recorded on the internet forum. The bad news adversely affect a vet's reputation that takes so much time and effort to build. So it is understandable if a vet does not want to operate on high-risk cases. I do avoid such cases if possible as deaths on the operating table means a beloved family member that has been growing up with the family children who have become adults is lost forever.
The average life-span of a big breed dog is 12 years. Oldest small breeds in Singapore can live up to 20 years. However, many die before they are 10 years of age due to bad health and other preventable causes such as bacterial infection of the heart valves due to severe gum diseases (preventable by regular 2-yearly dental scaling and checks), pyometra (preventable by early detection or spaying), kidney diseases, diabetes and tumours like breast, gum and circum-anal tumours. Many diseases such as circum-anal tumours rarely occur in male dogs that have been neutered. If you don't wish to neuter your dog, please check his backside monthly as small circum-anal tumours are easily removed and cost you less too.
Tumours are best removed when they are small.
Make an appointment with your pet shop groomer if you have a close working relationship with them and needs pet transport to the vet of your choice. Or tel 6254-3326, 9668-6469 for an appointment to discuss health screening for your senior companion. Or e-mail judy@toapayohvets.com your requirements.
Website with images are at:
http://www.toapayohvets.com/surgery/20080807Senior_Dogs_Health_Checks_ToaPayohVets.htm
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date: 21 September, 2011 toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
Most pet owners in Singapore live hectic lives. There is just too many distractions and too much work.
After an intense care for their puppies, the senior dogs are just left alone as there is no time for them after their puppyhood. It is usually too late for many dogs when they are sent to the veterinarian for some chronic disease problems. Veterinary costs become high as the dog is in poor health and need more intensive care.
Senior dogs are:
Small and Medium-sized breeds: Over 7 years
Large and Giant-sized breeds: Over 5 years.
For those who may want their senior dogs to live longer, here are the following recommendations available at Toa Payoh Vets:
1. Veterinary examination every 6-12 months including examination for tumours and growths, ear infections, eye diseases, skin diseases
2. Blood tests to check for blood disorders, diabetes, liver and kidney diseases.
3. Urine tests to check on bladder and kidney infections and presence of urinary stones.
4. X-rays for arthritic hip joints (can't stand up easily), spinal column, heart and lungs.
5. Dental check up and scaling every year.
6. Heart check for murmurs and heart diseases.
7. Stool test for blood, parasites
8. A report and discussion about the delay in senility, obesity, behavioural problems, skin problems and any questions related to each individual dog. Tumours detected early can be excised saving the dog's life and reducing veterinary costs.
An example of the investigation tests and surgeries done for one older dog with heart disease and another with gum tumour is shown below
Case 1: Heart disease confirmed in an old companion
Cardiac Tamponade in a Labrador Retriever - Pt 1 Cardiac Tamponade in a Labrador Retriever - Pt 2
subcutaneous swelling - edema - cardiac tamponade - heart base tumour likely - toapayohvets, singapore Cardiac tamponade, 13 days after pericardiocentesis, lab retriever, toapayohvets, singapore Labrador Retriever, Male, 8 years, short of breath, transthoracic echocardiography, toapayohvets, singapore
labrador retriever, male, 8 years, skin swellings, cardiac tamponade, toapayohvets, singapore labrador retriever, male, 8 years, skin swellings, cardiac tamponade, toapayohvets, singapore Labrador Retriever, Male, 8 years, short of breath, transthoracic echocardiography, toapayohvets, singapore
Case 2: Get tumours excised by your vet when they are smaller
Large cancerous gum and hard palate tumour. Jack Russell, 10 years. Toa Payoh Vets Isoflurane Gas Anaesthesia. Electro-cutting removed gum tumour first. Note hard palate tumour. Toa Payoh Vets
Large cancerous gum and hard palate tumour. Jack Russell, 10 years. Toa Payoh Vets Large cancerous gum and hard palate tumour. Jack Russell, 10 years. Toa Payoh Vets
Electrosurgery stops profuse bleeding during gum & hard palate tumour removal. Toa Payoh Vets Gum and hard palate tumours in old dogs can be prevented with good dental hygiene and health. Toa Payoh Vets.
Large cancerous gum and hard palate tumou excised. Jack Russell, 10 years. Toa Payoh Vets Jack Russell, Gum & Hard Palate Tumour excised. Vet Intern. Toa Payoh Vets.
Old dogs are very high anaesthetic risks as they are seldom in the best of health unlike younger ones. Everyone is happy when the old dog does not die on the operating table after surgery. But every vet will have cases of old dogs dying on the operating table as it is impossible to get good clinical outcomes when the vets undertake high-risk16 years old fox terrier, not neutered, male, circum-anal, tail gland tumours, toapayohvets, singapore anaesthetics. This is one main reason why some vets discourage or reject old dog surgeries. "The old dog will pass away before the circum-anal tumours grow much bigger," one vet said to the owner. But the dog lived longer, splattering the apartment with blood from the bleeding tumour and requiring frequent cleaning up.
When a dog dies on the operating table, it is just too emotional for everyone including the operating veterinary surgeon. Such deaths may be bad-mouthed by the owner or the family members to friends and recorded on the internet forum. The bad news adversely affect a vet's reputation that takes so much time and effort to build. So it is understandable if a vet does not want to operate on high-risk cases. I do avoid such cases if possible as deaths on the operating table means a beloved family member that has been growing up with the family children who have become adults is lost forever.
The average life-span of a big breed dog is 12 years. Oldest small breeds in Singapore can live up to 20 years. However, many die before they are 10 years of age due to bad health and other preventable causes such as bacterial infection of the heart valves due to severe gum diseases (preventable by regular 2-yearly dental scaling and checks), pyometra (preventable by early detection or spaying), kidney diseases, diabetes and tumours like breast, gum and circum-anal tumours. Many diseases such as circum-anal tumours rarely occur in male dogs that have been neutered. If you don't wish to neuter your dog, please check his backside monthly as small circum-anal tumours are easily removed and cost you less too.
Tumours are best removed when they are small.
Make an appointment with your pet shop groomer if you have a close working relationship with them and needs pet transport to the vet of your choice. Or tel 6254-3326, 9668-6469 for an appointment to discuss health screening for your senior companion. Or e-mail judy@toapayohvets.com your requirements.
Website with images are at:
http://www.toapayohvets.com/surgery/20080807Senior_Dogs_Health_Checks_ToaPayohVets.htm
Tuesday, September 20, 2011
619. Two weeks after surgery & treatment - pemphigus in a Shih Tzu - Part 4
Sunday Sep 18, 2011
The Shih Tzu is now so energetic and inquisitive that it was so hard to believe that she was causing so much distress to her caring lady owner for many weeks before treatment. She had literally a mouthful of "tumours" as you can see from the picture as follows:
The long history of this case is at:
1. http://www.sinpets.com/F6/201108031Five-oral-tumours-old-shih-tzu-singapore_ToaPayohVets.htm
2. http://www.sinpets.com/F6/20110902pemphigus-foliaceus-vulgaris-shih-tzu-singapore_ToaPayohVets.htm
"This is an auto-immune disease that will return if not treated with drugs," I explained to the owner that the dog's bodies produce antibodies to attack her skin cells.
At this review 2 weeks after surgery, it was sunshine as this old companion looked almost normal. What's more, she could eat and run, like a "reborn" dog.
"Is there another tumour inside the mouth?" the young lady asked me. The Shih Tzu objected to me opening her mouth. She twisted her head here and there. So, I took a picture when she yawned. "It is hard to say if she has another tumour inside the mouth," I replied. "Wait another two weeks."
I asked her to take the two types of auto-immune drugs and will review 2 weeks later. The dog had put on weight and the hair in the body had grown more. She looked so much prettier now that the hideouos lower lip and other mouth tumours had been excised by me using electro-surgery 2 weeks ago.
The drugs must be given at the lowest safest dose and this is why reviews and 3-6 monthly blood tests are necessary. In most cases, I don't see the owners coming for reviews after the first time. This is the culture of city living in Singapore and that is the way it is.
The Shih Tzu is now so energetic and inquisitive that it was so hard to believe that she was causing so much distress to her caring lady owner for many weeks before treatment. She had literally a mouthful of "tumours" as you can see from the picture as follows:
The long history of this case is at:
1. http://www.sinpets.com/F6/201108031Five-oral-tumours-old-shih-tzu-singapore_ToaPayohVets.htm
2. http://www.sinpets.com/F6/20110902pemphigus-foliaceus-vulgaris-shih-tzu-singapore_ToaPayohVets.htm
"This is an auto-immune disease that will return if not treated with drugs," I explained to the owner that the dog's bodies produce antibodies to attack her skin cells.
At this review 2 weeks after surgery, it was sunshine as this old companion looked almost normal. What's more, she could eat and run, like a "reborn" dog.
"Is there another tumour inside the mouth?" the young lady asked me. The Shih Tzu objected to me opening her mouth. She twisted her head here and there. So, I took a picture when she yawned. "It is hard to say if she has another tumour inside the mouth," I replied. "Wait another two weeks."
I asked her to take the two types of auto-immune drugs and will review 2 weeks later. The dog had put on weight and the hair in the body had grown more. She looked so much prettier now that the hideouos lower lip and other mouth tumours had been excised by me using electro-surgery 2 weeks ago.
The drugs must be given at the lowest safest dose and this is why reviews and 3-6 monthly blood tests are necessary. In most cases, I don't see the owners coming for reviews after the first time. This is the culture of city living in Singapore and that is the way it is.
619. House-call in Singapore
Toa Payoh Vets do make house-calls. The e-mail to Dr Sing is probably a case of a cat ringworm.
E-MAIL TO DR SING DATED SEP 20, 2011
Dear Vet Team ,
I have 3 Munchkin Kittens . At least one of them is growing a dermal fungus since yesterday .
As I m working trough the day I would like to take your service of home-visits .
I haven't been your client before so here my particularis :
Owner's particulars and address given
HP :
Patients : M1 (Blue Bi -Col , 4 Month , male ) , P1 (Gray Lepard Tabby , 4 Month , male ) , S1 (Ginger Bi-Col ,4 Month ,male )
It would be great if you would have time to visit me tomorrow evening after 7pm .
Thank you and best regards ,
E-MAIL TO DR SING DATED SEP 20, 2011
Dear Vet Team ,
I have 3 Munchkin Kittens . At least one of them is growing a dermal fungus since yesterday .
As I m working trough the day I would like to take your service of home-visits .
I haven't been your client before so here my particularis :
Owner's particulars and address given
HP :
Patients : M1 (Blue Bi -Col , 4 Month , male ) , P1 (Gray Lepard Tabby , 4 Month , male ) , S1 (Ginger Bi-Col ,4 Month ,male )
It would be great if you would have time to visit me tomorrow evening after 7pm .
Thank you and best regards ,
Monday, September 19, 2011
618. Urethral Obstruction in the Dog: Retrograde urohydropropulsion
Each vet has his own way of handling a case of urethral obstruction in the dog. The outcome may be similar in that the dog can pass urine normally but the post-operation complications and implications vary.
In the following case, the Miniature Schnauzer dribbled urine. X-ray showed the urethra blocked by more than 10 small stones 3x5 mm in diameter. The catheter was obstructed and could not pass into the bladder.
SURGICAL APPROACHES
1. Cystotomy and retrograde urohydropropulsion of the stones into the bladder.
2. Cystotomy and urethrostomy.
When there are too many stones, I usually take the second surgical approach. There will be less trauma to the glans penis and urethra as the urohydropropulsion (syringing 20-35 ml of water to push back the stones into the bladder). I will make a 0.5 mm cut behind the os penis, take out the stones with a forceps, close the urethra and skin. Then I take out the 3 stones from the bladder. In my experience, the urethral wound heals well if proper post-op care is given.
However, in some cases, the dog is sent home within 2 days after surgery. There is a lack of care by the owner due to inexperience in animal nursing. The wound breaks down and the urine leaks from the wound perpetually. This is because some owners do not bother to refer to the vet on seeing the wound breakdown, owing to various reasons. So, the first approach eliminates this post-op complication of an unnatural urethral gap as the penile urethra is not incised. All stones are taken out via the bladder in the first approach.
In this case, Vet 1 preferred the first approach. There are more than one surgical approaches in treating urethral obstruction and each has its own pros and cons.
However, on Saturday (my day off and 24 hours after surgery by Vet 1), I visited Toa Payoh Vets to check on this Miniature Schnauzer in the afternoon. I noted the glans penis was much swollen and so did the owner.
In this case, the dog was scheduled to go home 48 hours after surgery. The owner was concerned about this swollen glans penis - reddish and not able to get back inside the prepuce. This swelling is a post-op complication of retrograde urohydropropulsion in some cases. What makes it occur? It is due to the traumatic pressure of gripping the glans in the process of retrograde urohydropropulsion via a catheter.
Numerous small urinary stones inside the os penis (penile bone) can be removed via a urethrostomy or via flushing back into the bladder and removed via cystostomy
The Miniature Schnauzer dribbles urine for the past 2 weeks. Partial urethral obstruction with >10 small stones is seen in the X-ray. Cystostomy and urohydropropulsion removed the stones via the bladder. The owner and I see dog peeing normally as seen 2 days after the surgery before going home.
he catheter has not been able to pass through more than 10 cm inside the penis as its passage is obstructed by the numerous stones inside the penile urethra. To prevent it being dislodged as water is pumped into the catheter to push the stones back into the bladder for removal, the glans penis has been gripped as an anchor point, resulting in swelling. Gripping the penile bone may not be practical but will be preferred. In any case, the outcome was excellent in the sense that after 3 irrigations, the stones were pumped back into the bladder where they were removed. So, the penile urethra is not cut open.
In this case, there was a problem. I had to intervene to resolve this problem. I decided to give an anti-inflammatory pred injection which is not normally used after surgery. Leaving the glans penis to shrink will take many days and any traumatic injury to it will lead to much unhappiness for the owner as it will cost her money.
Although the dog has a big size 20 e-collar, the owner disagreed with me that the dog can can't reach his surgical area to bruise it. There was a small bruised area near his sutures (see picture). The lady owner told me that there was no way her dog could have licked that area since he had the collar. I said it was possible but there was no point arguing with an owner as she had not seen incidents in other cases.
Within 24 hours of the injection, the glans penis had shrunk by 50% and was much less inflamed (see picture). He peed normally, had a good appetite and an excellent caregiver. He was sent home on Sunday.
For dogs with swollen glans penis, it is best not to send home till the dog has recovered but that would take many days and trauma could still occur in the Surgery. NSAID does not work very well in such cases if they are given as the "first line of defence." NSAID was prescribed for the home stay.
More pictures are at:
http://www.sinpets.com/F6/20110920retrograde-hydrouropropulsion-singapore_ToaPayohVets.htm
In the following case, the Miniature Schnauzer dribbled urine. X-ray showed the urethra blocked by more than 10 small stones 3x5 mm in diameter. The catheter was obstructed and could not pass into the bladder.
SURGICAL APPROACHES
1. Cystotomy and retrograde urohydropropulsion of the stones into the bladder.
2. Cystotomy and urethrostomy.
When there are too many stones, I usually take the second surgical approach. There will be less trauma to the glans penis and urethra as the urohydropropulsion (syringing 20-35 ml of water to push back the stones into the bladder). I will make a 0.5 mm cut behind the os penis, take out the stones with a forceps, close the urethra and skin. Then I take out the 3 stones from the bladder. In my experience, the urethral wound heals well if proper post-op care is given.
However, in some cases, the dog is sent home within 2 days after surgery. There is a lack of care by the owner due to inexperience in animal nursing. The wound breaks down and the urine leaks from the wound perpetually. This is because some owners do not bother to refer to the vet on seeing the wound breakdown, owing to various reasons. So, the first approach eliminates this post-op complication of an unnatural urethral gap as the penile urethra is not incised. All stones are taken out via the bladder in the first approach.
In this case, Vet 1 preferred the first approach. There are more than one surgical approaches in treating urethral obstruction and each has its own pros and cons.
However, on Saturday (my day off and 24 hours after surgery by Vet 1), I visited Toa Payoh Vets to check on this Miniature Schnauzer in the afternoon. I noted the glans penis was much swollen and so did the owner.
In this case, the dog was scheduled to go home 48 hours after surgery. The owner was concerned about this swollen glans penis - reddish and not able to get back inside the prepuce. This swelling is a post-op complication of retrograde urohydropropulsion in some cases. What makes it occur? It is due to the traumatic pressure of gripping the glans in the process of retrograde urohydropropulsion via a catheter.
Numerous small urinary stones inside the os penis (penile bone) can be removed via a urethrostomy or via flushing back into the bladder and removed via cystostomy
The Miniature Schnauzer dribbles urine for the past 2 weeks. Partial urethral obstruction with >10 small stones is seen in the X-ray. Cystostomy and urohydropropulsion removed the stones via the bladder. The owner and I see dog peeing normally as seen 2 days after the surgery before going home.
he catheter has not been able to pass through more than 10 cm inside the penis as its passage is obstructed by the numerous stones inside the penile urethra. To prevent it being dislodged as water is pumped into the catheter to push the stones back into the bladder for removal, the glans penis has been gripped as an anchor point, resulting in swelling. Gripping the penile bone may not be practical but will be preferred. In any case, the outcome was excellent in the sense that after 3 irrigations, the stones were pumped back into the bladder where they were removed. So, the penile urethra is not cut open.
In this case, there was a problem. I had to intervene to resolve this problem. I decided to give an anti-inflammatory pred injection which is not normally used after surgery. Leaving the glans penis to shrink will take many days and any traumatic injury to it will lead to much unhappiness for the owner as it will cost her money.
Although the dog has a big size 20 e-collar, the owner disagreed with me that the dog can can't reach his surgical area to bruise it. There was a small bruised area near his sutures (see picture). The lady owner told me that there was no way her dog could have licked that area since he had the collar. I said it was possible but there was no point arguing with an owner as she had not seen incidents in other cases.
Within 24 hours of the injection, the glans penis had shrunk by 50% and was much less inflamed (see picture). He peed normally, had a good appetite and an excellent caregiver. He was sent home on Sunday.
For dogs with swollen glans penis, it is best not to send home till the dog has recovered but that would take many days and trauma could still occur in the Surgery. NSAID does not work very well in such cases if they are given as the "first line of defence." NSAID was prescribed for the home stay.
More pictures are at:
http://www.sinpets.com/F6/20110920retrograde-hydrouropropulsion-singapore_ToaPayohVets.htm
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