I spoke to Daniel, a Murdoch 5th year vet student who wrote a research article on the above subject and said it was inexpensive and fast and therefore should be used by vets.
I do not do regional nerve block in vet dentistry as the dog still needs General Anaesthesia, unlike human beings. Maybe in very old dogs? GA using isoflurane + oxygen is safe even for very old dogs. So I believe almost 99% of vets in private practice do not bother with regional nerve blocks in vet dentistry in the dog and cat.
However, I chanced upon a video on this subject today while doing my research for the AVA Responsible Pet Ownership 2011 Seminar on this Sat Nov 12,2011 at 1.3pm0 - 2 pm at Changi Expo. I will be showing videos rather than the boring Power Point Slides presentation. Probably only 10 adults and a few children will be present at this talk, from my past observations!
There is a video at:
http://www.youtube.com/watch?v=UtWUzkHnLTk&feature=related
Wednesday, November 9, 2011
Tuesday, November 8, 2011
725. AVA Responsible Pet Ownership Roadshow 2011
AVA Responsible Pet Ownership Roadshow 2011
12 & 13 November 2011
Singapore Expo Hall 4B
Toa Payoh Vets' Talk: Be A Responsible Home-breeder - Dystocia in the Dog
Story of 2 case studies - Small breeds with large pups
Experienced home-breeder. Arrangement with a vet to standby.
Inexperienced home-breeder. Veterinary Costs. Wait and See?
Delays in seeking Emergency Caesarean Section - What happens?
Hook 1 - After midnight emergency Caesarean Section
Video Scene of undertakers around Toa Payoh Vets. Ghosts roam after midnight? White apparitions seen outside clinic. Pass the case to other vets? Duty of care?
INTRODUCTION
MIDDLE - Case study 1. Experienced breeder saves surgery time.
Case study 2. Breeder does not know how to revive pup with water-logged lungs. I had to show. Swing hard but carefully. Picture.
CONCLUSION - Vet fees are higher after office hours. From $1,500 - $3,000.
Hook 2 - Public holiday
1. TRENDS IN SINGAPORE PET OWNERSHIP BY DR SING AS A VET FROM 1974 - 2011
1.1 MANY MORE CARING YOUNG ADULT SINGAPOREANS - BEST HEALTH CARE FOR THEIR PETS
1.2 CONFLICTS WITH SENIOR CITIZENS & DEPENDENTS - THE GOOGLE GENERATION V. SENIOR CITIZENS WHO ARE PRAGMATIC - BUYING A NEW PET IS CHEAPER THAN PAYING VET FEES. What values are imparted? Don't care when pets are old and sick? Get a new one!
2. ADVICES. DO NOT BREED. EMERGENCY CAESAREAN SECTIONS ARE RELATIVELY "EXPENSIVE" - FROM $1,500 - $3,000
3. IF YOU WANT TO BREED,
3.1 READ AND RESEARCH ON DOG PREGNANCY AND DYSTOCIAS IN YOUR BREED
3.2 BUILD A GOOD RELATIONSHIP OF TRUST WITH THEIR VET
3.3 BE ABLE TO AFFORD THE VET FEES FOR EMERGENCY CAESAREAN SECTIONS
3.4 FIND A VET WHO CHARGES $200 FOR A CAESAREAN SECTION?
3. MORE CAESAREAN SECTION CASE STUDIES BY DR SING AT:
http://www.bekindtopets.com/animals/20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm
CREDITS
PRODUCED AND NARRATED BY:
12 & 13 November 2011
Singapore Expo Hall 4B
Toa Payoh Vets' Talk: Be A Responsible Home-breeder - Dystocia in the Dog
Story of 2 case studies - Small breeds with large pups
Experienced home-breeder. Arrangement with a vet to standby.
Inexperienced home-breeder. Veterinary Costs. Wait and See?
Delays in seeking Emergency Caesarean Section - What happens?
Hook 1 - After midnight emergency Caesarean Section
Video Scene of undertakers around Toa Payoh Vets. Ghosts roam after midnight? White apparitions seen outside clinic. Pass the case to other vets? Duty of care?
INTRODUCTION
MIDDLE - Case study 1. Experienced breeder saves surgery time.
Case study 2. Breeder does not know how to revive pup with water-logged lungs. I had to show. Swing hard but carefully. Picture.
CONCLUSION - Vet fees are higher after office hours. From $1,500 - $3,000.
Hook 2 - Public holiday
1. TRENDS IN SINGAPORE PET OWNERSHIP BY DR SING AS A VET FROM 1974 - 2011
1.1 MANY MORE CARING YOUNG ADULT SINGAPOREANS - BEST HEALTH CARE FOR THEIR PETS
1.2 CONFLICTS WITH SENIOR CITIZENS & DEPENDENTS - THE GOOGLE GENERATION V. SENIOR CITIZENS WHO ARE PRAGMATIC - BUYING A NEW PET IS CHEAPER THAN PAYING VET FEES. What values are imparted? Don't care when pets are old and sick? Get a new one!
2. ADVICES. DO NOT BREED. EMERGENCY CAESAREAN SECTIONS ARE RELATIVELY "EXPENSIVE" - FROM $1,500 - $3,000
3. IF YOU WANT TO BREED,
3.1 READ AND RESEARCH ON DOG PREGNANCY AND DYSTOCIAS IN YOUR BREED
3.2 BUILD A GOOD RELATIONSHIP OF TRUST WITH THEIR VET
3.3 BE ABLE TO AFFORD THE VET FEES FOR EMERGENCY CAESAREAN SECTIONS
3.4 FIND A VET WHO CHARGES $200 FOR A CAESAREAN SECTION?
3. MORE CAESAREAN SECTION CASE STUDIES BY DR SING AT:
http://www.bekindtopets.com/animals/20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm
CREDITS
PRODUCED AND NARRATED BY:
Friday, November 4, 2011
724. Parasites/mites from dog to person
On Fri, Nov 4, 2011 at 12:43 AM, ...@gmail.com> wrote:
hi there, i've come across your website as i've been searching on google for an answer to my question:
my dog is currently being treated for parasites/mites, and now my daughter has strange bites and itches all over her arms and legs, could it be that the dog has passed her the parasites as well? what can i do for my daughter to help her as our family doctor's itching cream has not been working to relieve her itches at all.
thank you,
Name
E-MAIL REPLY FROM DR SING DATED NOV 4, 2011
You need to know what parasites/mites are involved in your dog by asking your vet to give you a vet report. Let the doctor know the diagnosis or seek a skin specialist/2nd opinion from another doctor.
hi there, i've come across your website as i've been searching on google for an answer to my question:
my dog is currently being treated for parasites/mites, and now my daughter has strange bites and itches all over her arms and legs, could it be that the dog has passed her the parasites as well? what can i do for my daughter to help her as our family doctor's itching cream has not been working to relieve her itches at all.
thank you,
Name
E-MAIL REPLY FROM DR SING DATED NOV 4, 2011
You need to know what parasites/mites are involved in your dog by asking your vet to give you a vet report. Let the doctor know the diagnosis or seek a skin specialist/2nd opinion from another doctor.
Thursday, November 3, 2011
723. House-call for Golden Retriever with ear area snipped
Nov 2, 2011.
"It sounds like a surgical case," I said to the lady who googled "house-call vets singapore" and phoned me as to whether I would do a house-call in East Singapore. She volunteered to bathe this dog. Her maid and the neighbour's were cleaning the neighbour's Golden Retriever. There was a big clump of matted hair behind the ear. So, the scissors cut off the matted lump. 50% of the skin depth was cut off too. Size of 4 cm x 5 cm. So, the kind lady phoned for a house call.
I got the transport man to bring the dog down to the Surgery at 12 noon.
A bit overweight.
SEDATION
28 kg. Unknown health status.
Domitor 0.4 + Ketamine 0.5 ml IV (1/3 calculated dose for 30kg, young healthy dog).
GR sedated within 1 minute but woke up
"It sounds like a surgical case," I said to the lady who googled "house-call vets singapore" and phoned me as to whether I would do a house-call in East Singapore. She volunteered to bathe this dog. Her maid and the neighbour's were cleaning the neighbour's Golden Retriever. There was a big clump of matted hair behind the ear. So, the scissors cut off the matted lump. 50% of the skin depth was cut off too. Size of 4 cm x 5 cm. So, the kind lady phoned for a house call.
I got the transport man to bring the dog down to the Surgery at 12 noon.
A bit overweight.
SEDATION
28 kg. Unknown health status.
Domitor 0.4 + Ketamine 0.5 ml IV (1/3 calculated dose for 30kg, young healthy dog).
GR sedated within 1 minute but woke up
722. Cracked RU PM4 in golden retriever
A young couple saw me today for a second opinion as the dog was chewing on the left side for the past 2 weeks. He was fed lamb shanks and raw diet for some years but recently cracked his RU Premolar.
A red hole 1 mm in diameter was obvious and so I thought it was the cause of the tooth ache. The owner had palpated the tooth and there was a sliding of the upper front part of the tooth and told me. Indeed, there was movement. I shone a torch.
Still it took nearly 30 minutes of review and palpation before I finally concluded that the dog actually had a V-shaped fracture sideways from the upper anterior end! At one review, red blood oozed out from the crack. A v-shaped side fracture!
That was why it was moving. The owner gave treats many times to prevent the dog biting the vet and so there was some distractions. But at least, it was not the gum.
A red hole 1 mm in diameter was obvious and so I thought it was the cause of the tooth ache. The owner had palpated the tooth and there was a sliding of the upper front part of the tooth and told me. Indeed, there was movement. I shone a torch.
Still it took nearly 30 minutes of review and palpation before I finally concluded that the dog actually had a V-shaped fracture sideways from the upper anterior end! At one review, red blood oozed out from the crack. A v-shaped side fracture!
That was why it was moving. The owner gave treats many times to prevent the dog biting the vet and so there was some distractions. But at least, it was not the gum.
721. Expert questions autopsy findings: liposuction death
Dr Stephen Leadbeatter, foerensic pathologist, Cardiff University, Wales Institute of Forensic Medicine told a coroner's enquiry into the liposuction death. He said that based on the available info, he could not ascertain which aspect of the operation caused the death of Mr Franklin Heng. He was the expert witness for Dr Jim Wong, a GP who carried out the procedure.
Health Sciences Authority (HSA) said the death was caused by mulltiple punctures in the intestines due to the liposuction. HSA consultant forensic pathologist said the holow steel tube used could have caused the patient to go into shock and died.
Dr leadbeatter's points for the defence are:
1. He saw images from the autopsy, but said it was unclear whether the puncture wounds had gone fully into the intestines.
2. He saw no signs of peritonitis, the thin lining of the peritoneal cavity. If there was full puncture, the intestinal contents would have spilled out of the intestines into the peritoneum.
3. Lack of info about the description of any intestinal contents in the peritoneal cavity
4. Lack of microscopy to determine peritonitis
5. Another possible cause of death could be fat emboism - fat entering the blood stream into the lungs and brain. He had seen only slides of the b rain, not other organs.
6. Mr Heng could have difficulty breathing from an allergic reaction. This issue was not addressed in the blood taken.
7. Propofol used as a sedative could have contributed to the death according to the autopsy report.
But Dr Leadbeatter said the concentration of drug in the blood after death might not correctly be the same amount at the time of death.
In my reading of the report, there was no info as to whether peritonitis was present or not present and it seemed that the intestinal punctures did not go into the full thickness of the intestines. Will follow up.
Health Sciences Authority (HSA) said the death was caused by mulltiple punctures in the intestines due to the liposuction. HSA consultant forensic pathologist said the holow steel tube used could have caused the patient to go into shock and died.
Dr leadbeatter's points for the defence are:
1. He saw images from the autopsy, but said it was unclear whether the puncture wounds had gone fully into the intestines.
2. He saw no signs of peritonitis, the thin lining of the peritoneal cavity. If there was full puncture, the intestinal contents would have spilled out of the intestines into the peritoneum.
3. Lack of info about the description of any intestinal contents in the peritoneal cavity
4. Lack of microscopy to determine peritonitis
5. Another possible cause of death could be fat emboism - fat entering the blood stream into the lungs and brain. He had seen only slides of the b rain, not other organs.
6. Mr Heng could have difficulty breathing from an allergic reaction. This issue was not addressed in the blood taken.
7. Propofol used as a sedative could have contributed to the death according to the autopsy report.
But Dr Leadbeatter said the concentration of drug in the blood after death might not correctly be the same amount at the time of death.
In my reading of the report, there was no info as to whether peritonitis was present or not present and it seemed that the intestinal punctures did not go into the full thickness of the intestines. Will follow up.
720. Tray-training a Golden Retriever puppy
On Tue, Nov 1, 2011 at 11:14 PM, ...@hotmail.com> wrote:
Hello there, came across a site where you've provided information of toilet training dogs. I current have some enquiries and I would be glad if you could help me with it. I've gotten a golden retriever pup 4 days ago and he is 2 month old. We've been crating him with a tray inside and some space left for him to lie down. So far while in the crate, when he needs to do his business he would do it on the tray and not on the empty space. However during the day, we will let him out to play and only let him in during his nap time. This has caused several accidents. However, after observing, we noticed some consistency in his pee and poo time so we bring him out when we feel he needs to release and hence the no of accident has decreased. We have another tray placed outside where I hope I can train him to do his business there. However every time we place him on the tray, he will start sniffing and will without fail walk out of the tray and do his business outside the tray. I have placed tissue soaked in his urine and poo with new newspaper on top of it and metal grill to prevent him from stepping on his pee or chewing the paper. I was wondering what should be done to train him to use the tray instead of the floor. Should I lease him so he cannot wonder off the tray or should I 'fence up' his toilet area and only let him out after he do his business. My friend recommended me to leave him in his crate for a month and not let him out at all even to play so he will get toilet trained . But I don't think it's a good idea to crate him up without letting him out as I'm afraid of complications such as too much energy not release and becoming destructive or excited once let out etc. I hope you can give me some advice on what to do. Your help will be greatly appreciated.
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I am Dr Sing from Toa Payoh Vets. I assume you want the puppy to pee and poop on a "tray". Is the tray of sufficient size as this is a big breed? What are the dimensions?
Pl send at least 3 images of housing and layout plan as what I visualise about the tools you are using for toilet-training, based on your text description, may be incorrect. A "tray" to you can be a floor grate + pee tray below to another dog owner.
Hello there, came across a site where you've provided information of toilet training dogs. I current have some enquiries and I would be glad if you could help me with it. I've gotten a golden retriever pup 4 days ago and he is 2 month old. We've been crating him with a tray inside and some space left for him to lie down. So far while in the crate, when he needs to do his business he would do it on the tray and not on the empty space. However during the day, we will let him out to play and only let him in during his nap time. This has caused several accidents. However, after observing, we noticed some consistency in his pee and poo time so we bring him out when we feel he needs to release and hence the no of accident has decreased. We have another tray placed outside where I hope I can train him to do his business there. However every time we place him on the tray, he will start sniffing and will without fail walk out of the tray and do his business outside the tray. I have placed tissue soaked in his urine and poo with new newspaper on top of it and metal grill to prevent him from stepping on his pee or chewing the paper. I was wondering what should be done to train him to use the tray instead of the floor. Should I lease him so he cannot wonder off the tray or should I 'fence up' his toilet area and only let him out after he do his business. My friend recommended me to leave him in his crate for a month and not let him out at all even to play so he will get toilet trained . But I don't think it's a good idea to crate him up without letting him out as I'm afraid of complications such as too much energy not release and becoming destructive or excited once let out etc. I hope you can give me some advice on what to do. Your help will be greatly appreciated.
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I am Dr Sing from Toa Payoh Vets. I assume you want the puppy to pee and poop on a "tray". Is the tray of sufficient size as this is a big breed? What are the dimensions?
Pl send at least 3 images of housing and layout plan as what I visualise about the tools you are using for toilet-training, based on your text description, may be incorrect. A "tray" to you can be a floor grate + pee tray below to another dog owner.
719. Update on animal activist's help of a tick fever rescue dog
Update on animal activist's help of a tick fever rescue dog
The Rescue Group's vet had said that imizole would not be effective against Babesia gibsoni and advised a triple-drug combination costing $1,000. The rescue group wanted this activist to pay $600 to top up the $600 budget from the rescue group. The activist sought my advice by text and there was some delays as the Rescue Group's vet said that Berenil would be available as a cheap alternative in a few days' time. So the activist waited. But no Berenil. The activist was pro-active and posted online for help. A donor responded and would pay for treatment by the donor's vet. It seems that this rescue dog will survive the tick fever and that is good news for her and for anyone.
The following is her reply to my follow-up on her rescue dog's status
E-MAIL TO DR SING DATED NOV 2, 2011
...@hotmail.com>
Hi,
Its been a busy few days.
The Berenil is discontinued in Singapore already, and the rescue people told me I have to pay myself or let her die. We brought her home on Saturday and on Sunday she was having difficulty breathing and could not stand up. I posted her pictures online and a very kind stranger offered to pay for her treatment on the condition that we go to her vet. ... is being treated at (Name of vet practice given) as requested by the donor.
Her red count had dropped even further, and her platelets dropped to only 12. She stayed there for 2 nights and they gave her lots of supportive fluid therapy, erythropoietin and used steroids to stop the hemolysis. She perked up very well and is now resting at home. We will repeat her blood count on Friday and give her Imizole on Saturday if all goes well. For now she is on pred, metronidazole, doxycyclin and some other supplements. I was also forcefeeding her Hill's a/d several times a day. As of this morning she was willingly eating herself! I think things are looking up and Dr ... thinks she will survive. I hope the Imizole works to cure the infection.
I'm sorry we were not able to take her to you. I have great faith in your clinic, but unfortunately the money is not mine! :(
Thank you so much for your concern, you are very kind..
Btw, she's not my dog! We are just fostering her and hopefully will find her a home.
Smile,
Name
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I thank you for being proactive in helping the stray dog. The vet is doing a great job and I am quite sure imizole will be effective. Best wishes.
The Rescue Group's vet had said that imizole would not be effective against Babesia gibsoni and advised a triple-drug combination costing $1,000. The rescue group wanted this activist to pay $600 to top up the $600 budget from the rescue group. The activist sought my advice by text and there was some delays as the Rescue Group's vet said that Berenil would be available as a cheap alternative in a few days' time. So the activist waited. But no Berenil. The activist was pro-active and posted online for help. A donor responded and would pay for treatment by the donor's vet. It seems that this rescue dog will survive the tick fever and that is good news for her and for anyone.
The following is her reply to my follow-up on her rescue dog's status
E-MAIL TO DR SING DATED NOV 2, 2011
...@hotmail.com>
Hi,
Its been a busy few days.
The Berenil is discontinued in Singapore already, and the rescue people told me I have to pay myself or let her die. We brought her home on Saturday and on Sunday she was having difficulty breathing and could not stand up. I posted her pictures online and a very kind stranger offered to pay for her treatment on the condition that we go to her vet. ... is being treated at (Name of vet practice given) as requested by the donor.
Her red count had dropped even further, and her platelets dropped to only 12. She stayed there for 2 nights and they gave her lots of supportive fluid therapy, erythropoietin and used steroids to stop the hemolysis. She perked up very well and is now resting at home. We will repeat her blood count on Friday and give her Imizole on Saturday if all goes well. For now she is on pred, metronidazole, doxycyclin and some other supplements. I was also forcefeeding her Hill's a/d several times a day. As of this morning she was willingly eating herself! I think things are looking up and Dr ... thinks she will survive. I hope the Imizole works to cure the infection.
I'm sorry we were not able to take her to you. I have great faith in your clinic, but unfortunately the money is not mine! :(
Thank you so much for your concern, you are very kind..
Btw, she's not my dog! We are just fostering her and hopefully will find her a home.
Smile,
Name
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I thank you for being proactive in helping the stray dog. The vet is doing a great job and I am quite sure imizole will be effective. Best wishes.
718. Follow up on Cocker Spaniel with tick fever - 14 days later
SUNDAY'S INTERESTING CASES
Oct 30, 2011
On Friday, Oct 28, 2011, I got a text message from a young lady caring for a Singapore Rescue Group's stray dog with tick fever diagnosed by Vet 1 consulted by the Group. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever would be ineffective as this dog had Babesia gibsoni.
As imizole is "ineffective" against Babesia gibsoni, Vet 1 wanted to use the "3 effective" drugs atovaquone, clindamycine and azithromycin. However, it would cost the Rescue Group $1,000. Berenil was cheaper but might cause anaphylaxic shock and in any case there was no stock at that time.
The Rescue Group asked her to top up the bill but she did not have the means to do so. So, she texted me for advice and alternative options.
Below are my replies to her.
It is kind of you to do dog rescue work. There are many financial considerations.
Combination of atovaquone, clindamycine and azithromycin by (required by Vet 1) as said by you, is claimed by Vet 1 to be effective against Babesia gibsoni infections in this dog. Vet 1 had said that imizole is ineffective against Babesia gibsoni.
I will not comment further as I don't use these expensive drugs. Success rate depends on follow up, not just one injection. Blood transfusion 1.5 bags at $500/bag and hospitalisation will be more than $600 budget from the Rescue group.
Berenil is cheap but anaphylaxis according to your text. Hb at 5 is low for your affected dog, but you also need to know total RBC.
In conclusion, anti-tick fever treatment is not cheap due to prolonged treatment and follow ups.
E-MAIL TO DR SING DATED Oct 29 (2 days ago)
Thank you very much Dr Sing. I am heading out to check on the dog this morning. If the rescue doesn't want to pay for treatment, I think I will bring the dog home to die as she doesn't like the cage...
Thanks again. Will email u soon.
Name given
COMMENTS
The dog was sent home without the expensive treatment or imizole. The lady activist thought that the dog was "alone" at the vet clinic and she would take the dog home to die. Berenil would be available possibly 2 days later.
Coincidentally, I was following up on an English cocker spaniel, 11.5 kg with Babesia gibsoni and Ehrlichia tick fever 10 days ago. A Cocker Spaniel has tick fever in 2011 is the case report.
Day 1 to Day 5 of tick fever
She came today (Sunday Oct 30, 2011) for her 2nd imizole injection (0.6 ml SC today) 10 days after the first injection (0.5 ml SC). Based on her active normal behaviour and much pinker gums, the first imizole injection had worked. Otherwise she should be dead by now.
So, should Vet 1 have given imizole to that stray dog rather than wait for the cheaper Berenil to be available later? Is imizole totally ineffective against Babesia gibsoni? I related the story of the stray dog with tick fever to the cocker spaniel and she was worried that I had not given the correct treatment.
Day 1 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 10 --->
"Will you dog be active and rushing out to play and have pink gums 10 days after the first injection if imizole was ineffective?" I asked her as I gave the 2nd injection today. As the dog still had ticks attached to her head and spinal area, I asked: "Does your dog go under the bed?". She said "Yes, my dog likes to sleep under the bed." I said: "Ticks may be present on the under part of the bed and attaches to the dog. Advantix should work as this spot-on was given 10 days ago when the dog came in. Give another dose in 4 days." I wanted to prescribe the anti-tick wash but did not as I asked her to use the Advantix and the dog had not many ticks.
My thoughts on this fine Sunday morning were for that stray dog and the caregiver who was a student. The young Singaporeans prefer to text and on Saturday, Oct 29, 2011, 2.53 pm, I got the following:
"Dr Sing, I brought the dog home as they could not do anything for her. Rescue opted to try Berenil but can't get for a few days so we are waiting. She is very weak. I think she may be dying. How much is one shot of imizole? Do u think it is worth a try? If not too expensive, I don't mind trying myself. What else can we do for her in the meantime?
I phoned her on Saturday and told her to bring the dog for the imizole injection on Saturday at 9.30 am. But she said that the transport was not available. In any case, the Berenil may be available on Monday and the dog was still alive. So I hope that this dog had the Berenil treatment soon.
As for the English Cocker Spaniel, as at Nov 3, 2011, the dog is normal. "Except that she tires easily," the owner said to me. She submitted a urine sample for testing. The values were normal. The urine SG was high, at 1.041 (range should be 1.005 -1.030), pH was 7.0 and struvite crystals were present. "Could it be the high liver I am feeding?" the lady asked me. "Should I stop feeding the liver?" She was also feeding iron supplements and all the good home-cooked food. "Since your dog tires easily, she has not fully recovered her normal red cell amount," I said. "The high urine SG is unusual. It shows that the kidneys can concentrate the urine well but what causes it is hard to say." I may need to have another urine test 2 weeks later.
Nov 3, 2011, as I update this report, I had been thinking about the high urine SG. My hypothesis is that the destruction of so many red and white blood cells damaged by the Babesia and Ehrlichia organisms during the past 14 days would have contributed to a large amount of protein damage for the past few days. The kidneys are normal and have to work hard to excrete the urea. This resulted in a high urine SG. There may be a high blood urea but I did not take a blood sample when the urine sample was sent.
Since the kidneys and bladder were normal, there was no proteinuria during urinalysis. Is this hypothesis sound? These are the types of questions the professor may ask in a case study during the final exam of the 5th year vet student. I remembered my "viva" or "oral exam" on a case study during my final year by my Professor of Vet Medicine and an external examiner and I presume Murdoch vet students still get this oral test.
A reply or hypothesis may not be possible for a vet student so much burdened with 5 years of vet knowledge memorised to pass the Final examination in November 2011 if the Professor of Vet Medicine asked about the high SG during the oral test!
Earlier report: A Cocker Spaniel has tick fever in 2011 or
http://www.sinpets.com/dogs/20111039tick-fever-cocker-spaniel-singapore-toapayohvets.htm
IT IS NOT POSSIBLE FOR ME TO POST THE VARIOUS EDUCATIONAL IMAGES ON BLOGGER.COM
UPDATES AND MORE IMAGES WILL BE AT TOA PAYOH VETS
http://www.sinpets.com/dogs/20111036babesia-gibsoni-treatment-drug-imizole-success-singapore-toapayohvets.htm
Oct 30, 2011
On Friday, Oct 28, 2011, I got a text message from a young lady caring for a Singapore Rescue Group's stray dog with tick fever diagnosed by Vet 1 consulted by the Group. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever would be ineffective as this dog had Babesia gibsoni.
As imizole is "ineffective" against Babesia gibsoni, Vet 1 wanted to use the "3 effective" drugs atovaquone, clindamycine and azithromycin. However, it would cost the Rescue Group $1,000. Berenil was cheaper but might cause anaphylaxic shock and in any case there was no stock at that time.
The Rescue Group asked her to top up the bill but she did not have the means to do so. So, she texted me for advice and alternative options.
Below are my replies to her.
It is kind of you to do dog rescue work. There are many financial considerations.
Combination of atovaquone, clindamycine and azithromycin by (required by Vet 1) as said by you, is claimed by Vet 1 to be effective against Babesia gibsoni infections in this dog. Vet 1 had said that imizole is ineffective against Babesia gibsoni.
I will not comment further as I don't use these expensive drugs. Success rate depends on follow up, not just one injection. Blood transfusion 1.5 bags at $500/bag and hospitalisation will be more than $600 budget from the Rescue group.
Berenil is cheap but anaphylaxis according to your text. Hb at 5 is low for your affected dog, but you also need to know total RBC.
In conclusion, anti-tick fever treatment is not cheap due to prolonged treatment and follow ups.
E-MAIL TO DR SING DATED Oct 29 (2 days ago)
Thank you very much Dr Sing. I am heading out to check on the dog this morning. If the rescue doesn't want to pay for treatment, I think I will bring the dog home to die as she doesn't like the cage...
Thanks again. Will email u soon.
Name given
COMMENTS
The dog was sent home without the expensive treatment or imizole. The lady activist thought that the dog was "alone" at the vet clinic and she would take the dog home to die. Berenil would be available possibly 2 days later.
Coincidentally, I was following up on an English cocker spaniel, 11.5 kg with Babesia gibsoni and Ehrlichia tick fever 10 days ago. A Cocker Spaniel has tick fever in 2011 is the case report.
Day 1 to Day 5 of tick fever
She came today (Sunday Oct 30, 2011) for her 2nd imizole injection (0.6 ml SC today) 10 days after the first injection (0.5 ml SC). Based on her active normal behaviour and much pinker gums, the first imizole injection had worked. Otherwise she should be dead by now.
So, should Vet 1 have given imizole to that stray dog rather than wait for the cheaper Berenil to be available later? Is imizole totally ineffective against Babesia gibsoni? I related the story of the stray dog with tick fever to the cocker spaniel and she was worried that I had not given the correct treatment.
Day 1 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 10 --->
"Will you dog be active and rushing out to play and have pink gums 10 days after the first injection if imizole was ineffective?" I asked her as I gave the 2nd injection today. As the dog still had ticks attached to her head and spinal area, I asked: "Does your dog go under the bed?". She said "Yes, my dog likes to sleep under the bed." I said: "Ticks may be present on the under part of the bed and attaches to the dog. Advantix should work as this spot-on was given 10 days ago when the dog came in. Give another dose in 4 days." I wanted to prescribe the anti-tick wash but did not as I asked her to use the Advantix and the dog had not many ticks.
My thoughts on this fine Sunday morning were for that stray dog and the caregiver who was a student. The young Singaporeans prefer to text and on Saturday, Oct 29, 2011, 2.53 pm, I got the following:
"Dr Sing, I brought the dog home as they could not do anything for her. Rescue opted to try Berenil but can't get for a few days so we are waiting. She is very weak. I think she may be dying. How much is one shot of imizole? Do u think it is worth a try? If not too expensive, I don't mind trying myself. What else can we do for her in the meantime?
I phoned her on Saturday and told her to bring the dog for the imizole injection on Saturday at 9.30 am. But she said that the transport was not available. In any case, the Berenil may be available on Monday and the dog was still alive. So I hope that this dog had the Berenil treatment soon.
As for the English Cocker Spaniel, as at Nov 3, 2011, the dog is normal. "Except that she tires easily," the owner said to me. She submitted a urine sample for testing. The values were normal. The urine SG was high, at 1.041 (range should be 1.005 -1.030), pH was 7.0 and struvite crystals were present. "Could it be the high liver I am feeding?" the lady asked me. "Should I stop feeding the liver?" She was also feeding iron supplements and all the good home-cooked food. "Since your dog tires easily, she has not fully recovered her normal red cell amount," I said. "The high urine SG is unusual. It shows that the kidneys can concentrate the urine well but what causes it is hard to say." I may need to have another urine test 2 weeks later.
Nov 3, 2011, as I update this report, I had been thinking about the high urine SG. My hypothesis is that the destruction of so many red and white blood cells damaged by the Babesia and Ehrlichia organisms during the past 14 days would have contributed to a large amount of protein damage for the past few days. The kidneys are normal and have to work hard to excrete the urea. This resulted in a high urine SG. There may be a high blood urea but I did not take a blood sample when the urine sample was sent.
Since the kidneys and bladder were normal, there was no proteinuria during urinalysis. Is this hypothesis sound? These are the types of questions the professor may ask in a case study during the final exam of the 5th year vet student. I remembered my "viva" or "oral exam" on a case study during my final year by my Professor of Vet Medicine and an external examiner and I presume Murdoch vet students still get this oral test.
A reply or hypothesis may not be possible for a vet student so much burdened with 5 years of vet knowledge memorised to pass the Final examination in November 2011 if the Professor of Vet Medicine asked about the high SG during the oral test!
Earlier report: A Cocker Spaniel has tick fever in 2011 or
http://www.sinpets.com/dogs/20111039tick-fever-cocker-spaniel-singapore-toapayohvets.htm
IT IS NOT POSSIBLE FOR ME TO POST THE VARIOUS EDUCATIONAL IMAGES ON BLOGGER.COM
UPDATES AND MORE IMAGES WILL BE AT TOA PAYOH VETS
http://www.sinpets.com/dogs/20111036babesia-gibsoni-treatment-drug-imizole-success-singapore-toapayohvets.htm
Tuesday, November 1, 2011
717. Recurrent UTI in an old Corgi is hard to treat
Recurrent UTI in an old Corgi is hard to treat
Every dog owner and probably person will be warned about anaesthetic risks. For owners who don't want the risk, there are groomers in Singapore who find this opportunity to provide a service involving dental scaling of dogs without any anaesthesia.
Vets do not use anaesthetic on dogs unnecessary to avoid any anaesthetic risks as the high emotions of grieving of dogs dead during anaesthesia are terrible for the vet and the staff.
Since most dogs will not tolerate manual dental scaling, the groomer's assistant must grip the dog's legs tight to enforce cooperation. It is like the old days when people are held tightly by men during surgeries or given a dose of whisky. In dogs, the groomer can't sedate as the service is supposed to be no anaesthetic or sedation.
Recently I had a case of a poodle that had stopped eating for over 3 days and could not stand up. The two teenaged daughters were worried that their dog may die. The mother had taken the dog to a groomer in Sembawang pet shop to get dental scaling done. I remembered this case as the mother was running a mini-mart and I had vaccinated her dog some 3 years ago. It was a puppy then. I had the dog's blood checked, gave the IV drip and antibiotics. There was hypoglycaemia. The dog's mouth probably was very painful after enforced dental scaling by the groomer and so he would not eat. He recovered within 2 days of treatment and went home to two happy teenaged daughters and a relieved mother.
Yesterday, Oct 31, 2011, I had this 9-year-old Corgi whose lady owner was vacillating as to whether to get her dental scaling done or not. Her dog would lick at the vagina after the course of antibiotics lasting as long as one month and the urine would have blood clots or blood when all the antibiotics have been taken.
She had consulted several vets in one brand name practice for more than 10 times over the last two years after being referred to this practice by another vet who could not cure her dog's blood in the urine problem. This was because the brand name practice has all the facilities, according to the vet referring her to this practice. Ultrasound of the kidney and bladders, urine tests, urine culture and sensitivity and blood tests were done at various times over the two years. There was said to be an X-ray done but the practice said there was no record available.
But her dog would pass smelly urine with blood after a course of antibiotics prescribed by these vets. She was not happy with this situation. One vet had advised surgery of the bladder to remove "polyps" but had told her about anaesthetic risk and that the surgery was not meant to be a cure for the recurring problem of passing blood in the urine.
She phoned me to seek another opinion recently. I have the benefit of these tests. Three urine tests at different times showed struvites in the urine. The facilities or tools of the trade were used by the vets but the owner's problems were not resolved.
It was like my car's problem. My car would display "Check coolant level" and I would send the car to my usual mechanic for 4 times. The mechanics were two older men in their late 60s distinguished with snow-white hairs and specialising in the brand of car I drove. I presumed they must have the experience as their hairs were all white. I never bargained or squeezed them for discount after they service my car, as is the case with many pet owners at Toa Payoh Vets.
At the 4th time "Check coolant level," message flashed, I asked the mechanic whether he could do the job. I had to replace 2000 ml of water in 5 days after he had assured me that he had resolved my problem.
I cannot afford putting my car overnight and then encounter the same problem again. The old man pointed to some water spots on the radiator and said he knew what to do. He diagnosed the radiator cap as being damaged and therefore leaked the coolant. He said he had used pressure tests and there was no other leakage. Earlier he had put some liquid which could seal any cracks but they did not work.
Yet, I got the same problem. On the 5th time, he said he would check again. He said the 5-month-old German-made radiator was faulty and had replaced with a French-made radiator. The supplier of the German-made radiator would not provide a replacement and therefore I had to pay him $500. "The 'check coolant level' was reported within 2 months of getting the German-made radiator," I said. "I wish to speak to the distributor as he is selling faulty goods and cheating people." The old man said it was of no use. "I was referred to another mechanic down the road," I said to the old man. "You could not resolve my problem for so many times."
With the new radiator replaced, I checked the water level 5 days later. There was a need to top up 200 ml of water. So, was there a leakage or not? I have to wait and see.
My situation is similar with that of the Corgi owner as I entrusted my mechanic to resolve my problem. He recommended replacement of the radiator and some pumps and the bill came up to $7,000!
Only that she had consulted the same practice for over 10 times without resolution of her problems and I would not be surprised if she had spent $7,000 too. I did not ask her. But I could empathise with her.
DENTAL SCALING DONE TODAY
I use the same guideline for sedation
A 10-kg healthy young dog - 0.4 ml domitor + 0.5 ml ketamine IV
The Corgi weighed around 14 kg but she was old. Blood tests were normal but no chest x-ray of the heart was done today as this is the usual practice. In human anaesthesia, a chest x-ray at Singapore General Hospital where I went for surgery, was mandatory.
In this Corgi, I gave 0.1 ml domitor + 0.1 ml ketamine mixed with 0. 3 ml normal saline and gave IV. This was less than 20% of the formula but the dog was sedated 80%. I used isoflurane gas to top up.
"No need," my assistant Min said when I told him to apply a tourniquet.
"Sometimes it is not needed," I said. "But I see that you have wasted a lot of time in some cases where no tourniquet was used as the blood collection or injection was not possible at the first attempt."
The dog had a tourniquet and the cephalic vein was distended. The sedatives were given.
I monitored the isoflurane gas + oxygen very carefully as the lady owner entrusted me and expected the dog to be OK. Eyelid blinking to be zero and maintenance of isoflurane was 0.5 - 1%. The dog had bilateral cataracts but I could monitor the closing of the pupil. It still took 45 minutes to complete the whole dental scaling. Solid teeth. Tartar only esp. on PM4 upper, both sides.
The owner had said, "My dog had only one anaesthesia and that was when she was spayed." I said: "That was some 6 years ago and she was healthy then. I advise an X-ray of the chest."
ULTRASOUND OF THE BLADDER AND X-RAY OF THE CHEST AND ABDOMEN AT 11.30 AM
I collaborate with an experienced vet who did the ultrasound and X-rays. I brought the Corgi personally to discuss with him the use of the tools of the trade - the ultrasound and the X-rays and how he would interpret the results. I had wanted a contrast cystography involving injecting dyes into the dog and X-raying the kidneys and bladder to check for tumours and stones. However the cost of $500 inclusive of anaesthesia was above budget. I had to find other lower cost alternatives and in any case, there was anaesthesia which I had just performed during dental scaling in the morning.
To cut a long story short, the ultrasound showed lots of floating sandy particles inside the bladder as reported by previous vets doing the ultrasound. There was thickened bladder wall but no polyps or transitional cell carcinoma inside the bladder. "Otherwise the Doppler would show blood flowing into the mass on the inside of the bladder," the vet I collaborated with said to me. "There was zero blood flow and therefore the sandy particles were separate from any mucosa." Excellent use of the tools of the trade, I must commend him.
On X-rays, I could see radio-dense bladder indicative of struvites (as reported by urine tests by the previous vets). The owner collected urine in the morning but I had treated the dog with antibiotics 2 days ago. I wanted the X-ray to see if there were large struvite stones. There were none.
Lots of radio-dense sandy particles float inside the bladder. Could they be struvite sand or inflammatory cells?
Yet the urine test taken on the same day is negative for epithelial, white blood and red blood cells and crystals, mucus threads, yeast and bacteria.
The urine test I sent to the lab today show normal urine. Amber, clear, no nitrite, protein, glucose, ketones, urobilinogen (normal), bilirubin, blood. Urine microscopy - no white or ed blood cells, no epithelial cells, casts, crystals, bacteria, mucus threads. yeast or others.
The pH was 7.0 (5-8) and SG was 1.018 (1.0905-1.030).
Based on history, the sandy particles would be struvites or inflammatory cells.
I had to treat the dog 2 days ago as it was quite distressing for the owner. In any case, urine bacterial culture and sensitivity tests had been done by the other vets and Proteus mirabilis was found in one time. So, I did not repeat again to save the owner some money. Baytril had worked and the dog was no more passing blood in the urine while on antibiotics.
What is the next step now that the bladder is shown to be free from tumours and polyps which would cause recurrent UTI? I recommend dental scaling which was done. The next step would be SD diet for 3-4 months to acidify the urine. If this works, it will be happy days for the owner. I will use urine acidifiers and review the case in 4 weeks. Will I succeed where others fail? Only time will tell whether I can resolve the lady's pet problem of recurring UTI. This dog was well beloved as not many Singapore owners would bother to take the dog for over 10 times to treat for blood in the urine. One or two times and that's it for the old girl!
CONCLUSION
The history of the case reports from the other vets is much more important than one urine test. I would say that struvite and inflammatory cells are present.
The dog has chronic cystitis and recurrent UTI. Tumours have been ruled out as a cause. Blood test before antibiotic treatment was normal and so a other-source of infection via the blood is ruled out. This leaves struvites are a cause. The pH 7.0 is not acidic. Nor alkaline but this should be reduced to produce acidic urine to stop bacterial growth.
P.S. The dog's heart was enlarged but when I auscultated the heart, the heart sounds were normal. "Why is the heart enlarged?" the owner asked. "It may be due to old age or congenital or other reasons," I said. The dog did feel short of breath at certain times. Will update this webpage.
Updates will be at: Toa Payoh Vets webpage:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm
Every dog owner and probably person will be warned about anaesthetic risks. For owners who don't want the risk, there are groomers in Singapore who find this opportunity to provide a service involving dental scaling of dogs without any anaesthesia.
Vets do not use anaesthetic on dogs unnecessary to avoid any anaesthetic risks as the high emotions of grieving of dogs dead during anaesthesia are terrible for the vet and the staff.
Since most dogs will not tolerate manual dental scaling, the groomer's assistant must grip the dog's legs tight to enforce cooperation. It is like the old days when people are held tightly by men during surgeries or given a dose of whisky. In dogs, the groomer can't sedate as the service is supposed to be no anaesthetic or sedation.
Recently I had a case of a poodle that had stopped eating for over 3 days and could not stand up. The two teenaged daughters were worried that their dog may die. The mother had taken the dog to a groomer in Sembawang pet shop to get dental scaling done. I remembered this case as the mother was running a mini-mart and I had vaccinated her dog some 3 years ago. It was a puppy then. I had the dog's blood checked, gave the IV drip and antibiotics. There was hypoglycaemia. The dog's mouth probably was very painful after enforced dental scaling by the groomer and so he would not eat. He recovered within 2 days of treatment and went home to two happy teenaged daughters and a relieved mother.
Yesterday, Oct 31, 2011, I had this 9-year-old Corgi whose lady owner was vacillating as to whether to get her dental scaling done or not. Her dog would lick at the vagina after the course of antibiotics lasting as long as one month and the urine would have blood clots or blood when all the antibiotics have been taken.
She had consulted several vets in one brand name practice for more than 10 times over the last two years after being referred to this practice by another vet who could not cure her dog's blood in the urine problem. This was because the brand name practice has all the facilities, according to the vet referring her to this practice. Ultrasound of the kidney and bladders, urine tests, urine culture and sensitivity and blood tests were done at various times over the two years. There was said to be an X-ray done but the practice said there was no record available.
But her dog would pass smelly urine with blood after a course of antibiotics prescribed by these vets. She was not happy with this situation. One vet had advised surgery of the bladder to remove "polyps" but had told her about anaesthetic risk and that the surgery was not meant to be a cure for the recurring problem of passing blood in the urine.
She phoned me to seek another opinion recently. I have the benefit of these tests. Three urine tests at different times showed struvites in the urine. The facilities or tools of the trade were used by the vets but the owner's problems were not resolved.
It was like my car's problem. My car would display "Check coolant level" and I would send the car to my usual mechanic for 4 times. The mechanics were two older men in their late 60s distinguished with snow-white hairs and specialising in the brand of car I drove. I presumed they must have the experience as their hairs were all white. I never bargained or squeezed them for discount after they service my car, as is the case with many pet owners at Toa Payoh Vets.
At the 4th time "Check coolant level," message flashed, I asked the mechanic whether he could do the job. I had to replace 2000 ml of water in 5 days after he had assured me that he had resolved my problem.
I cannot afford putting my car overnight and then encounter the same problem again. The old man pointed to some water spots on the radiator and said he knew what to do. He diagnosed the radiator cap as being damaged and therefore leaked the coolant. He said he had used pressure tests and there was no other leakage. Earlier he had put some liquid which could seal any cracks but they did not work.
Yet, I got the same problem. On the 5th time, he said he would check again. He said the 5-month-old German-made radiator was faulty and had replaced with a French-made radiator. The supplier of the German-made radiator would not provide a replacement and therefore I had to pay him $500. "The 'check coolant level' was reported within 2 months of getting the German-made radiator," I said. "I wish to speak to the distributor as he is selling faulty goods and cheating people." The old man said it was of no use. "I was referred to another mechanic down the road," I said to the old man. "You could not resolve my problem for so many times."
With the new radiator replaced, I checked the water level 5 days later. There was a need to top up 200 ml of water. So, was there a leakage or not? I have to wait and see.
My situation is similar with that of the Corgi owner as I entrusted my mechanic to resolve my problem. He recommended replacement of the radiator and some pumps and the bill came up to $7,000!
Only that she had consulted the same practice for over 10 times without resolution of her problems and I would not be surprised if she had spent $7,000 too. I did not ask her. But I could empathise with her.
DENTAL SCALING DONE TODAY
I use the same guideline for sedation
A 10-kg healthy young dog - 0.4 ml domitor + 0.5 ml ketamine IV
The Corgi weighed around 14 kg but she was old. Blood tests were normal but no chest x-ray of the heart was done today as this is the usual practice. In human anaesthesia, a chest x-ray at Singapore General Hospital where I went for surgery, was mandatory.
In this Corgi, I gave 0.1 ml domitor + 0.1 ml ketamine mixed with 0. 3 ml normal saline and gave IV. This was less than 20% of the formula but the dog was sedated 80%. I used isoflurane gas to top up.
"No need," my assistant Min said when I told him to apply a tourniquet.
"Sometimes it is not needed," I said. "But I see that you have wasted a lot of time in some cases where no tourniquet was used as the blood collection or injection was not possible at the first attempt."
The dog had a tourniquet and the cephalic vein was distended. The sedatives were given.
I monitored the isoflurane gas + oxygen very carefully as the lady owner entrusted me and expected the dog to be OK. Eyelid blinking to be zero and maintenance of isoflurane was 0.5 - 1%. The dog had bilateral cataracts but I could monitor the closing of the pupil. It still took 45 minutes to complete the whole dental scaling. Solid teeth. Tartar only esp. on PM4 upper, both sides.
The owner had said, "My dog had only one anaesthesia and that was when she was spayed." I said: "That was some 6 years ago and she was healthy then. I advise an X-ray of the chest."
ULTRASOUND OF THE BLADDER AND X-RAY OF THE CHEST AND ABDOMEN AT 11.30 AM
I collaborate with an experienced vet who did the ultrasound and X-rays. I brought the Corgi personally to discuss with him the use of the tools of the trade - the ultrasound and the X-rays and how he would interpret the results. I had wanted a contrast cystography involving injecting dyes into the dog and X-raying the kidneys and bladder to check for tumours and stones. However the cost of $500 inclusive of anaesthesia was above budget. I had to find other lower cost alternatives and in any case, there was anaesthesia which I had just performed during dental scaling in the morning.
To cut a long story short, the ultrasound showed lots of floating sandy particles inside the bladder as reported by previous vets doing the ultrasound. There was thickened bladder wall but no polyps or transitional cell carcinoma inside the bladder. "Otherwise the Doppler would show blood flowing into the mass on the inside of the bladder," the vet I collaborated with said to me. "There was zero blood flow and therefore the sandy particles were separate from any mucosa." Excellent use of the tools of the trade, I must commend him.
On X-rays, I could see radio-dense bladder indicative of struvites (as reported by urine tests by the previous vets). The owner collected urine in the morning but I had treated the dog with antibiotics 2 days ago. I wanted the X-ray to see if there were large struvite stones. There were none.
Lots of radio-dense sandy particles float inside the bladder. Could they be struvite sand or inflammatory cells?
Yet the urine test taken on the same day is negative for epithelial, white blood and red blood cells and crystals, mucus threads, yeast and bacteria.
The urine test I sent to the lab today show normal urine. Amber, clear, no nitrite, protein, glucose, ketones, urobilinogen (normal), bilirubin, blood. Urine microscopy - no white or ed blood cells, no epithelial cells, casts, crystals, bacteria, mucus threads. yeast or others.
The pH was 7.0 (5-8) and SG was 1.018 (1.0905-1.030).
Based on history, the sandy particles would be struvites or inflammatory cells.
I had to treat the dog 2 days ago as it was quite distressing for the owner. In any case, urine bacterial culture and sensitivity tests had been done by the other vets and Proteus mirabilis was found in one time. So, I did not repeat again to save the owner some money. Baytril had worked and the dog was no more passing blood in the urine while on antibiotics.
What is the next step now that the bladder is shown to be free from tumours and polyps which would cause recurrent UTI? I recommend dental scaling which was done. The next step would be SD diet for 3-4 months to acidify the urine. If this works, it will be happy days for the owner. I will use urine acidifiers and review the case in 4 weeks. Will I succeed where others fail? Only time will tell whether I can resolve the lady's pet problem of recurring UTI. This dog was well beloved as not many Singapore owners would bother to take the dog for over 10 times to treat for blood in the urine. One or two times and that's it for the old girl!
CONCLUSION
The history of the case reports from the other vets is much more important than one urine test. I would say that struvite and inflammatory cells are present.
The dog has chronic cystitis and recurrent UTI. Tumours have been ruled out as a cause. Blood test before antibiotic treatment was normal and so a other-source of infection via the blood is ruled out. This leaves struvites are a cause. The pH 7.0 is not acidic. Nor alkaline but this should be reduced to produce acidic urine to stop bacterial growth.
P.S. The dog's heart was enlarged but when I auscultated the heart, the heart sounds were normal. "Why is the heart enlarged?" the owner asked. "It may be due to old age or congenital or other reasons," I said. The dog did feel short of breath at certain times. Will update this webpage.
Updates will be at: Toa Payoh Vets webpage:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm
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