The couple came with a Schnazuer boarded for 20 days. Ear infection and loose stools with blood. So, the pet shop operator asked her to consult a vet after discharge.
Know the history of the pet shop. This pet shop sells many puppies and has a history of parvoviral deaths. So I told Dr Vanessa that parvoviral tests must be done. Blood tests were taken. There was a fever.
Examination - pus in both ears.
Test - faecal parvovirus negative
Friday, September 30, 2011
649. Old Fox Terrier with ear infections for the last 10 years
RINGWORM IN AN OLD FOX TERRIER, Male, 12 year
"Ringworm comes 2x per year for the last 10 years," the senior citizen who lived nearby had been consulting a vet for the last 10 year as his dog showed ear irritation. "The vet advises ear canal ablation," he said. The chest on both sides and the back legs were bald too.
A loud liquid swishing sound in both ears as his wife poured commercial ear drops.
"This flooding of the ear canal would never permit it to heal." The ear surface near the opening of the vertical canals were scratched black. No ear pain but full of yellow liquid, I noted in my record.
"When you started seeing the vet?" I asked.
"Since my Fox Terrier was to 2 3 years old."
I did a blood and urine test. Nothing abnormal. 10 kg was good weight. Only bad breath. Teeth looked sound. Epulis on gums.
Sedated. Irrigated the ears. Advised the owner not to flood the ear canals every day. Keep the canal dry. To review in 4 weeks.
That was Jun 2011. In Sep, the owner came saying that there were some scales on the back. "Ringworm again," he said.
"I did ask you for a review after medication for 20 days," I replied. He did not turn up.
However, he was much pleased with the hairs having re-grown on the sides of the chests. Skin diseases like ringworm are hard to treat if the owner's home hygiene is not up to the standard. Similar for ear infections. A combination of drugs and injection apparently cured 80% of his dog's problems. Otherwise, he would need to consult another vet.
RINGWORM IN AN OLD CHIHUAHUA, Female, Spayed, 12 years
"I am used to consulting you," the wife came at 9.30 am. Her husband accompanied her.
Ringworm circular patches and scales esp. around the neck. Very itchy. She was not infected.
"Ringworm again," I said. She said the ringworm came some years ago after going to a groomer. So she bought her own clipper to shave the hairs down to the skin. But still ringworm after consulting my associate vet. So she wanted to consult me.
Skin disease cases need a lot of time and patience to know the lifestyle of the dog and client. The home environment. The grooming schedule and type.
"Your clipper has lots of ringworm spores," I explained to her. "You did not disinfect it with proper anti-ringworm medication."
"I use lysol disinfectant," she said.
"Not effective.
"Did you clip the dog all bald 100%?" I asked.
"I leave some hair on the neck," she said. Later her husband told me she also left the tail unclipped.
"So the ringworm comes back because the remaining hairs are contaminated."
The couple were satisfied with my explanation about the cause and the need to be hygienic. Should have no more ringworm, I hope. "Slim her down," I said to the wife as the dog loved to eat. "Otherwise she would have heart disease."
This husband seems to me to love his wife very much and even took time off to get her dog to the vet for ringworm. Instead of self-treatment.
"Ringworm comes 2x per year for the last 10 years," the senior citizen who lived nearby had been consulting a vet for the last 10 year as his dog showed ear irritation. "The vet advises ear canal ablation," he said. The chest on both sides and the back legs were bald too.
A loud liquid swishing sound in both ears as his wife poured commercial ear drops.
"This flooding of the ear canal would never permit it to heal." The ear surface near the opening of the vertical canals were scratched black. No ear pain but full of yellow liquid, I noted in my record.
"When you started seeing the vet?" I asked.
"Since my Fox Terrier was to 2 3 years old."
I did a blood and urine test. Nothing abnormal. 10 kg was good weight. Only bad breath. Teeth looked sound. Epulis on gums.
Sedated. Irrigated the ears. Advised the owner not to flood the ear canals every day. Keep the canal dry. To review in 4 weeks.
That was Jun 2011. In Sep, the owner came saying that there were some scales on the back. "Ringworm again," he said.
"I did ask you for a review after medication for 20 days," I replied. He did not turn up.
However, he was much pleased with the hairs having re-grown on the sides of the chests. Skin diseases like ringworm are hard to treat if the owner's home hygiene is not up to the standard. Similar for ear infections. A combination of drugs and injection apparently cured 80% of his dog's problems. Otherwise, he would need to consult another vet.
RINGWORM IN AN OLD CHIHUAHUA, Female, Spayed, 12 years
"I am used to consulting you," the wife came at 9.30 am. Her husband accompanied her.
Ringworm circular patches and scales esp. around the neck. Very itchy. She was not infected.
"Ringworm again," I said. She said the ringworm came some years ago after going to a groomer. So she bought her own clipper to shave the hairs down to the skin. But still ringworm after consulting my associate vet. So she wanted to consult me.
Skin disease cases need a lot of time and patience to know the lifestyle of the dog and client. The home environment. The grooming schedule and type.
"Your clipper has lots of ringworm spores," I explained to her. "You did not disinfect it with proper anti-ringworm medication."
"I use lysol disinfectant," she said.
"Not effective.
"Did you clip the dog all bald 100%?" I asked.
"I leave some hair on the neck," she said. Later her husband told me she also left the tail unclipped.
"So the ringworm comes back because the remaining hairs are contaminated."
The couple were satisfied with my explanation about the cause and the need to be hygienic. Should have no more ringworm, I hope. "Slim her down," I said to the wife as the dog loved to eat. "Otherwise she would have heart disease."
This husband seems to me to love his wife very much and even took time off to get her dog to the vet for ringworm. Instead of self-treatment.
648. Dwarf hamster, female, 7 months, everted pouch
The young lady's vet gave a baytril 1% oral antibiotic 2 days ago. He said he would not operate as he was not able to do so. The lady surfed the net. Isoflurane gas - the assistant must focus on this. Dr Vanessa operated with me. Clamped pouch. Hamster woke up. Anaesthesia. Excised with scalpel. Anesthesia again. Stitch 6/0 absorbable x 3 interrupted.
"Don't stress the hamster," I said. "Unclamp as the hamster had woken up. Anaesthesia again."
The pouch was thus stitched.
Questions asked by owner:
1. Feed liquid food? Not need.
2. Can she store food? Not much as 80% had been cut off.
3. What if she did not get surgery done?
Pus already in pouch. Gangrene tip. Hamster will die from infections.
"Warts seen in right ear," I said. "If they grow bigger or the hamster feels itchy, they need to be excised." Presently her vet had give some anti-fungal wash to the other hamster with similar problem. Both hamsters live by themselves.
"Don't stress the hamster," I said. "Unclamp as the hamster had woken up. Anaesthesia again."
The pouch was thus stitched.
Questions asked by owner:
1. Feed liquid food? Not need.
2. Can she store food? Not much as 80% had been cut off.
3. What if she did not get surgery done?
Pus already in pouch. Gangrene tip. Hamster will die from infections.
"Warts seen in right ear," I said. "If they grow bigger or the hamster feels itchy, they need to be excised." Presently her vet had give some anti-fungal wash to the other hamster with similar problem. Both hamsters live by themselves.
647. Parvovirus still kills puppies and young dogs
Recently I had a chat with Vet 1 regarding the importance of evidence-based medicine in the diagnosis of vomiting and diarrhoea in puppies. There was presented a case of a puppy with vomiting and diarrhoea vaccinated 5 days ago. Vet 1 did not think it was parvovirus since the puppy had been vaccinated and the recent vaccination was 5 days ago.
Vet 1 showed me two comments about parvovirus infections in a short paragraph in veterinary medicine text book edited by US vets. These comments are:
1. Parvoviral tests will provide false positive if the puppy has been vaccinated from 5 - 10 days ago.
2. Most puppies with parvoviral infections survive when given supportive treatment.
POINT NO. 1
Apparently one Singapore vet had remarked to Vet 1 that parvovirus test will show a false positive when the puppy had been vaccinated 5 days ago. Therefore, Vet 1 showed me the book which stated the same. I said: "Will Vet 1 put in writing that he or she finds that a positive parvoviral test is a false positive? I doubt it. The puppy may have got vaccinated 5 days ago but it could be incubating the parvoviral infections before that and shows positive on the test. So, it can also be a true positive."
In any case, I got this puppy which was vaccinated 5 days ago but suffering from vomiting and diarrhoea tested for parvovirus. It was positive.
POINT NO. 2
"From my experience in working with the professional dog breeders in Pasir Ris for around 2-3 years, covering almost all the breeders, I know that parvovirus kills puppies despite supportive treatment," I said. "This observation has had been reported by various breeders and vets in countries like Australia.
"Much depends on the immune status and age of the puppies, the number of vaccinations, whether the dams have had been regularly vaccinated to produce maternal antibodies, the environmental load of parvoviruses and the strains. The author of the book cannot be trusted as he wrote a generalised statement. Young puppies with one or no vaccinations rarely survive even with supportive treatment because they are very young and their immune system is not developed. Breeders sometimes miss out regular vaccinations of their dams and it is extremely difficult for breeders to isolate infected puppies owing to their management system of cleaning crates with the same brushes."
IMAGE SHOWS A CASE OF PARVOVIRUS WHERE THE PUPPY WAS VACCINATED 5 DAYS AGO AND SOLD. A DIAGNOSIS OF PARVOVIRUS ON EVIDENCE-BASED MEDICINE NEEDS A BLOOD TEST, PARVOVIRAL TEST TO CONFIRM THE CLINICAL SIGNS OF VOMITING AND DIARRHOEA.
In rare cases, expensive supportive treatment like blood transfusion, intensive care, IV drips, antibodies, long hospitalisations may save the odd puppy. But how many owners are willing to pay for such treatments which are not guaranteed to save the puppy? The puppy costs $500 - $1,000. Do you really expect the owner to shell out much more to save it without a guarantee of success? There will be owners but not many.
Two years ago, one pet shop girl told me that her staff spent $20,000 to treat her puppy with vomiting and diarrhoea at a veterinary practice when I tested it to be positive for parvovirus. The staff took the puppy to another practice for treatment since I gave a poor prognosis. I had no reason to doubt her story although it does sound incredible.
In the past years, I used to go to pet shops to vaccinate puppies even if there were only 2-3 puppies and got to know more about the practices of the pet shops and breeders. But I have stopped doing it nowadays as I need to spend more time with my private patients to build up the practice rather than being "not around" when I went to the pet shops and breeders.
Despite advances of the world's technologies, parvoviruses still kill puppies in 2011 and in some cases, young dogs that have not been vaccinated properly or not vaccinated.
website:
http://www.sinpets.com/dogs/20110926parvovirus-kills-puppies-singapore_ToaPayohVets.htm
646. Update of the massive perineal hernia in a Silkie Terrier 10 weeks later
FOLLOW UP ON CASE RECORDED AT:
http://www.sinpets.com/F5/20110714perineal_hernia
_old_Silkie_Terrier_male_dysuria_painful_backside_singapore_ToaPayohVets.htm
Yesterday, Sep 28, 2011, I neutered the Silkie Terrier that I had took 2.5 hours to operate to repair the bilateral hernias some weeks ago. I had asked the owner to return for neuter in 2 weeks' time after discharge but they did not do so.
Perineal hernias occur mainly in the older male, non-neutered dogs. Neutering removes the male hormones that favour the development of perineal hernias. I did not neuter the dog earlier as he is an old dog and anaesthesias are best kept to the shortest to ensure survival. After all, what the owner and vet want is a living dog at the end of surgery.
The dog had passed blood in the stools for the second time and that was why the owner sent the dog to me. "Why didn't you send the dog in for neutering as advised?" I asked. The left perineal hernia had recurred. The owners said they were busy travelling.
The blood in the stools was not present when the dog came in. The stools were loose. The dog looked great and had a glossy black coat and wagged his short tail whenever I see him. "It is the same Silkie," the owner assured me. "You can see the stitches in his backside hernia!"
10 weeks ago, a massive bilateral perineal hernia --->
Neutering was advised 2 weeks after recovery from the hernia repair. Neutering would reduce the male dog's frequent urine-marking behaviour (uncommon or much less urge in neutered males).
Straining the pelvic muscles is caused by urine-marking. Perineal hernias develop during old age, when the pelvic diaphragm muscles have been weakened.
10 weeks later, the dog came in for stools in the blood. The left perineal hernia had recurred bu on a smaller scale. Neutering was done.
Perineal hernia recurs 10 weeks later --->
The first approach will be to neuter the dog. Incredibly, around 12 hours after neutering, the perineal hernia had gone down by 80% in swelling when I saw him at 8 pm. He was neutered at 9.30 am on Thursday Sep 28, 2011. I could not believe it. The hernia had softened as the intestines and probably bladder had gone back into the abdomen on its own accord. I will have to wait and see.
ANAESTHESIA
6.4 kg. Domitor 0.1 + Ketamine 0.1 = 0.2 ml IV with normal saline 0.2 ml. This is much below my guideline of Domitor 0.4 + Ketamine 0.5 ml IV for a healthy 10 kg dog.
Isoflurane gas for 2 minutes
Intubated and given isoflurane gas
The dog stopped breathing and emergency measures were performed. I did cardiac massage and blowing into the endotracheal tube for around 5 minutes. The heart started beating and the dog started breathing.
Thereafter, isoflurane gas top up by mask was given in short doses of less than 30 seconds by mask. As the dog woke up from Stage 4 and vocalised, my assistant gave the isoflurane gas by mask for less than 30 seconds. As part of my mentoring, I gave a tip to my assistant Mr Min to monitor the depth of anesthesia using the eye blinking reflex. Once the blinking has ceased and the eye white rolls downwards, the dog is progressing into the Stage 4 which is surgical anaesthesia. The dog closed his eyes too.
In this case, the endotracheal tube was taken out as the dog did give a "vomiting" action earlier. Patience, focus on isoflurane effects and a longer time was needed to neuter the dog. The dog woke up immediately after surgery, therefore there was no need for Antisedan reversal of domitor. He was on the Stage 3 and Stage 4 anaesthesia and therefore woke up immediately since the dosage was slightly under.
As to what caused the cessation of breathing, it is hard to say. The dog's blood test was normal but he may have lung or other internal health problems, being an old dog. The dog had a 2.5 hour anaesthesia earlier with no problems.
Anaesthesia in old dogs is always a big risk. The left perineal hernia would need to be repaired as it was half the size of an orange. Otherwise the blood in the stools would present again as the intestines get trapped inside the hernia. If neutering stops further enlargement of the hernia, then no more repair would be done. We would wait and see as we don't want to take the anaesthetic risk in a well beloved old dog. I gave a Tardak 1.3 ml SC injection and the dog would go home on day 2 after neuter. The dog is much loved by the patriarch and he is such a happy friendly Silkie Terrier that can win the hearts of everyone. And the love of its owners.
Update and more images are at:
http://www.sinpets.com/F6/20110931perineal-hernia-recurrence-not-neutered-silkie-terrier-singapore_ToaPayohVets.htm
http://www.sinpets.com/F5/20110714perineal_hernia
_old_Silkie_Terrier_male_dysuria_painful_backside_singapore_ToaPayohVets.htm
Yesterday, Sep 28, 2011, I neutered the Silkie Terrier that I had took 2.5 hours to operate to repair the bilateral hernias some weeks ago. I had asked the owner to return for neuter in 2 weeks' time after discharge but they did not do so.
Perineal hernias occur mainly in the older male, non-neutered dogs. Neutering removes the male hormones that favour the development of perineal hernias. I did not neuter the dog earlier as he is an old dog and anaesthesias are best kept to the shortest to ensure survival. After all, what the owner and vet want is a living dog at the end of surgery.
The dog had passed blood in the stools for the second time and that was why the owner sent the dog to me. "Why didn't you send the dog in for neutering as advised?" I asked. The left perineal hernia had recurred. The owners said they were busy travelling.
The blood in the stools was not present when the dog came in. The stools were loose. The dog looked great and had a glossy black coat and wagged his short tail whenever I see him. "It is the same Silkie," the owner assured me. "You can see the stitches in his backside hernia!"
10 weeks ago, a massive bilateral perineal hernia --->
Neutering was advised 2 weeks after recovery from the hernia repair. Neutering would reduce the male dog's frequent urine-marking behaviour (uncommon or much less urge in neutered males).
Straining the pelvic muscles is caused by urine-marking. Perineal hernias develop during old age, when the pelvic diaphragm muscles have been weakened.
10 weeks later, the dog came in for stools in the blood. The left perineal hernia had recurred bu on a smaller scale. Neutering was done.
Perineal hernia recurs 10 weeks later --->
The first approach will be to neuter the dog. Incredibly, around 12 hours after neutering, the perineal hernia had gone down by 80% in swelling when I saw him at 8 pm. He was neutered at 9.30 am on Thursday Sep 28, 2011. I could not believe it. The hernia had softened as the intestines and probably bladder had gone back into the abdomen on its own accord. I will have to wait and see.
ANAESTHESIA
6.4 kg. Domitor 0.1 + Ketamine 0.1 = 0.2 ml IV with normal saline 0.2 ml. This is much below my guideline of Domitor 0.4 + Ketamine 0.5 ml IV for a healthy 10 kg dog.
Isoflurane gas for 2 minutes
Intubated and given isoflurane gas
The dog stopped breathing and emergency measures were performed. I did cardiac massage and blowing into the endotracheal tube for around 5 minutes. The heart started beating and the dog started breathing.
Thereafter, isoflurane gas top up by mask was given in short doses of less than 30 seconds by mask. As the dog woke up from Stage 4 and vocalised, my assistant gave the isoflurane gas by mask for less than 30 seconds. As part of my mentoring, I gave a tip to my assistant Mr Min to monitor the depth of anesthesia using the eye blinking reflex. Once the blinking has ceased and the eye white rolls downwards, the dog is progressing into the Stage 4 which is surgical anaesthesia. The dog closed his eyes too.
In this case, the endotracheal tube was taken out as the dog did give a "vomiting" action earlier. Patience, focus on isoflurane effects and a longer time was needed to neuter the dog. The dog woke up immediately after surgery, therefore there was no need for Antisedan reversal of domitor. He was on the Stage 3 and Stage 4 anaesthesia and therefore woke up immediately since the dosage was slightly under.
As to what caused the cessation of breathing, it is hard to say. The dog's blood test was normal but he may have lung or other internal health problems, being an old dog. The dog had a 2.5 hour anaesthesia earlier with no problems.
Anaesthesia in old dogs is always a big risk. The left perineal hernia would need to be repaired as it was half the size of an orange. Otherwise the blood in the stools would present again as the intestines get trapped inside the hernia. If neutering stops further enlargement of the hernia, then no more repair would be done. We would wait and see as we don't want to take the anaesthetic risk in a well beloved old dog. I gave a Tardak 1.3 ml SC injection and the dog would go home on day 2 after neuter. The dog is much loved by the patriarch and he is such a happy friendly Silkie Terrier that can win the hearts of everyone. And the love of its owners.
Update and more images are at:
http://www.sinpets.com/F6/20110931perineal-hernia-recurrence-not-neutered-silkie-terrier-singapore_ToaPayohVets.htm
Thursday, September 29, 2011
645. Singapore General Hospital - Pre-operation evaluation - anaesthetic risks
On Sep 28, 2011, I went to the SGH for a pre-op evaluation at 12.30 pm.
My general practitioner diagnosed a cyst behind my right thumb as part of an auto-immune disease. "This is not good news," I said. "Well, you asked me," he said and as I wanted a surgeon, he advised me to see Dr Foo. "Well, Dr Foo will refer you to a dermatologist," he said. But Prof Foo diagnosed it as a synovial cyst, drew an illustration in his case sheet and booked me for the pre-op evaluation and surgery. "You know that GA (general anaesthesia) carries risk," as I opted out of regional anaesthesia.
PRE-OP PROCEDURES ARE:
1. Blood test. A 20G needle with needle holder sucked blood from my left elbow vein into 3 tubes. No news is good news, the anaesthetist told me as not all tests were completed when she saw me at 2 pm.
2. ECG - 10 electrodes attached to me. ECG normal written in the print out.
3. X-ray - chest. Nothing abnormal.
4. Weight and height measured for BMI and Blood Pressure taken by a machine that costs $5,000 and need to be serviced half-yearly. The nurse was most cheerful.
My general practitioner diagnosed a cyst behind my right thumb as part of an auto-immune disease. "This is not good news," I said. "Well, you asked me," he said and as I wanted a surgeon, he advised me to see Dr Foo. "Well, Dr Foo will refer you to a dermatologist," he said. But Prof Foo diagnosed it as a synovial cyst, drew an illustration in his case sheet and booked me for the pre-op evaluation and surgery. "You know that GA (general anaesthesia) carries risk," as I opted out of regional anaesthesia.
PRE-OP PROCEDURES ARE:
1. Blood test. A 20G needle with needle holder sucked blood from my left elbow vein into 3 tubes. No news is good news, the anaesthetist told me as not all tests were completed when she saw me at 2 pm.
2. ECG - 10 electrodes attached to me. ECG normal written in the print out.
3. X-ray - chest. Nothing abnormal.
4. Weight and height measured for BMI and Blood Pressure taken by a machine that costs $5,000 and need to be serviced half-yearly. The nurse was most cheerful.
Teach the young ones compassion to the disadvantaged and aged
Show our young ones how to help the disadvantaged and the poor and they will grow up to be kinder human beings
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