Yesterday, Dec 8, 2011, I was consulted about a Shih Tzu that was "paralysed". The sister had phoned me on Dec 7 for a 3rd opinion and I had asked her to send the dog in for examination as it is difficult to know what is going on by phone diagnosis.
The dog was treated by Dr Vanessa on Dec 7 and so I asked her where was the area of pain. I had seen the dog lying sideways in the crate. My assistant Min said Dr Vanessa had treated the dog. She came in around 11.30 am. I was about to talk to Dr Vanessa when the brother came in. This was the best time as it is always good for the owner to be involved in the examination.
AREA OF SPINAL PAIN
The dog had been treated by Vets 1 and 2 with steroids and so the area of spinal pain was not specifically known to Dr Vanessa when she received the dog. "Which area of the spine is painful?" I asked her since she had given a steroid injection and any pain would be masked.
The dog was able to lift his head but was unable to stand on four legs and that was definitely injury to the central nervous system. "Slight pain is further to the back area," Dr Vanessa said. It would be difficult to diagnose pain in the spinal area when the dog had been treated with pain-killers by Vets 1 and 2. Their medical records were brief. Acupuncture was done by Vet 2. But both of them had not done any X-ray. Later in the evening, the sister who had taken the dog to the vet spoke to me and said that she was given the choice of "X-ray" and/or "MRI."
There seemed to be some miscommunication here. Since I did not speak to Vets 1 and 2, I would presume that they had advised X-ray and the owners had opted out but the owner had said she was not a professional and should not be given a choice. It is extremely difficult nowadays. I usually advise X-ray in such traumatic cases and if the owner declines, I will record it down in my medical record. This is to avoid this type of "mis-communication".
For this report, I would focus on the pupillary light reflex done on the Shih Tzu in the presence of the brother. A bright light was shone directly on each eye to check the consensual and direct pupillary light reflex
DIRECT EYE REFLEX
Left eye - pupil does not constrict
Right eye - pupil constricts
So, what is the problem?
See notes from Wikipedia below.
Clinical significance
In addition to controlling the amount of light that enters the eye, the pupillary light reflex provides a useful diagnostic tool. It allows for testing the integrity of the sensory and motor functions of the eye.[1]
Under normal conditions, the pupils of both eyes respond identically to a light stimulus, regardless of which eye is being stimulated. Light entering one eye produces a constriction of the pupil of that eye, the direct response, as well as a constriction of the pupil of the unstimulated eye, the consensual response. Comparing these two responses in both eyes is helpful in locating a lesion.[1][5]
For example, a direct response in the right pupil without a consensual response in the left pupil suggests a problem with the motor connection to the left pupil (perhaps as a result of damage to the oculomotor nerve or Edinger-Westphal nucleus of the brain stem). Lack of response to light stimulation of the right eye if both eyes respond normally to stimulation of the left eye indicates damage to the sensory input from the right eye (perhaps to the right retina or optic nerve).[1]
Emergency room physicians routinely assess the pupillary reflex because it is useful for gauging brain stem function. Normally, pupils react (i.e. constrict) equally. Lack of the pupillary reflex or an abnormal pupillary reflex can be caused by optic nerve damage, oculomotor nerve damage, brain stem death and depressant drugs, such as barbiturates.
Normally, both pupils should constrict with light shone into either eye alone. On testing each reflex for each eye, several patterns are possible.[6]
Optic nerve damage on one side: (Example in parens.: Left optic nerve lesion)
The ipsilateral direct reflex is lost (Example: when the left eye is stimulated, neither pupil constricts, as no signals reach the brain from the left eye due to its damaged optic nerve)
The ipsilateral consensual reflex is INTACT (because light shone into the right eye can signal to the brain, causing constriction of both pupils via the normal oculomotor nerves)
The contralateral direct reflex is intact (because light shone into the right eye can signal to the brain, causing constriction of both pupils via the normal oculomotor nerves)
The contralateral consensual reflex is lost (because light shone into the eye on the damaged side cannot signal to the brain; therefore, despite the right eye's motor pathway (oculomotor nerve) being intact, no signals from the left eye are able to stimulate it due to the damage to the sensory pathway (optic nerve) of the left eye)
Oculomotor nerve damage on one side: (Example in parens: Left oculomotor lesion)
The ipsilateral direct reflex is lost (Example: when the left eye is stimulated, only the right pupil constricts)
The ipsilateral consensual reflex is lost (Example: when the right eye is stimulated, only the right pupil constricts)
The contralateral direct reflex is intact (because light shone into both eyes can still signal to the brain, and the pupil on the undamaged side will still be able to constrict via its normal oculomotor nerve)
The contralateral consensual reflex is intact (because light shone into the left eye can still signal to the brain via the normal optic nerve, causing attempted constriction of both pupils; the contralateral pupil constricts via its normal oculomotor nerve, but the ipsilateral pupil is unable to constrict due to its damaged oculomotor nerve)
I will write more later
Friday, December 9, 2011
Wednesday, December 7, 2011
782. The cat with foul-smelling ears claws the owner ferociously
"My cat cannot walk properly, hunching her back and not walking normally with the hind body upright. What is the problem?"
The cat walked with hind limbs low on the floor as if stalking a prey. Hind limb lameness. Why?
As I did a full body check, the cat's ears were strongly smelling of bad rotten flesh. "Did you get the ears treated?" I asked the lady.
"I consulted the vets (at another practice) twice," the woman said to me. "They give me ear drops. The cat scratches me when I tried applying the ear drops. I gave up."
On the surface, it seems that ear infections and lameness are not related. Yet if you think about being a cat. What would you do if you have such painful smelly ears over the last few months? You would try to relieve your itchy ears with your back paws. Both ears. Both paws. You do it so often and over the months. Would you not strain your hind limbs and joints? Ear drops were not applied. You claw your owners for doing it. So, in time, you feel the back pain in trying to relieve your ear itchiness and hurt your back muscles. So you slink when you walk. Can't walk upright. A hypothesis.
That's my theory. "I will sedate the cat after a day of antibiotics and anti-mite injection," I said to the owner. It was a surprise to her that I had proposed this approach as she expected me to prescribe "ear drops".
Today, 2nd day. The ear stench was much reduced. The cat still clawed but much less. The right ear had lots of wax and debris. Will irrigate the ears under anaesthesia and hope that this will help the cat not to sufer any more pain. The last option would be surgery to open up the vertical ear canal. But not now. Wait and see after ear irrigation and painkiller/antibioitc medication which is a simple way.
The cat walked with hind limbs low on the floor as if stalking a prey. Hind limb lameness. Why?
As I did a full body check, the cat's ears were strongly smelling of bad rotten flesh. "Did you get the ears treated?" I asked the lady.
"I consulted the vets (at another practice) twice," the woman said to me. "They give me ear drops. The cat scratches me when I tried applying the ear drops. I gave up."
On the surface, it seems that ear infections and lameness are not related. Yet if you think about being a cat. What would you do if you have such painful smelly ears over the last few months? You would try to relieve your itchy ears with your back paws. Both ears. Both paws. You do it so often and over the months. Would you not strain your hind limbs and joints? Ear drops were not applied. You claw your owners for doing it. So, in time, you feel the back pain in trying to relieve your ear itchiness and hurt your back muscles. So you slink when you walk. Can't walk upright. A hypothesis.
That's my theory. "I will sedate the cat after a day of antibiotics and anti-mite injection," I said to the owner. It was a surprise to her that I had proposed this approach as she expected me to prescribe "ear drops".
Today, 2nd day. The ear stench was much reduced. The cat still clawed but much less. The right ear had lots of wax and debris. Will irrigate the ears under anaesthesia and hope that this will help the cat not to sufer any more pain. The last option would be surgery to open up the vertical ear canal. But not now. Wait and see after ear irrigation and painkiller/antibioitc medication which is a simple way.
781. The father's day present
Yesterday, Tuesday, I worked past 7.30 pm and at 5 pm, I met a senior citizen who brought in a gold and white Shih Tzu of around 8 months old, with a bleeding toe nail. Dr Vanessa had treated it and bandaged the left hind foot.
"I better not do it myself next time," the taxi driver told me.
"Why did you buy this gold and white shih Tzu?" I asked.
"My son bought it for me," he said. "A present on Father's Day. From his friend."
I was surprised that the undergraduate with a scholarship would buy such a big responsibility for his father.
It was a good gift since the father loved the dog. "My wife used to dislike dogs," he told me. "But after getting this one, she loves dogs."
"That is great news," I said. "How is his toilet training?"
"I put his urine on the newspapers and he just go to the papers every time he needs to pee and poop," the father held on tightly to this high-maintenance dog.
"This is an intelligent dog," I said. "However, he is very thin. Feel the sharp spines," I showed the father. The thick luxuriant coat had covered up the thinness of the body.
I advised adding dry dog food to the usual canned food, at 80% dry food and the dog would put on weight. The son is good as now his parents have some company in an empty nest. Aged parents become "children" nowadays and so it is good that the dog keeps them company.
"I better not do it myself next time," the taxi driver told me.
"Why did you buy this gold and white shih Tzu?" I asked.
"My son bought it for me," he said. "A present on Father's Day. From his friend."
I was surprised that the undergraduate with a scholarship would buy such a big responsibility for his father.
It was a good gift since the father loved the dog. "My wife used to dislike dogs," he told me. "But after getting this one, she loves dogs."
"That is great news," I said. "How is his toilet training?"
"I put his urine on the newspapers and he just go to the papers every time he needs to pee and poop," the father held on tightly to this high-maintenance dog.
"This is an intelligent dog," I said. "However, he is very thin. Feel the sharp spines," I showed the father. The thick luxuriant coat had covered up the thinness of the body.
I advised adding dry dog food to the usual canned food, at 80% dry food and the dog would put on weight. The son is good as now his parents have some company in an empty nest. Aged parents become "children" nowadays and so it is good that the dog keeps them company.
780. The 1.5-year-old cat started spraying his urine is under the scalpel today
Wednesday morning.
A mother and her teenaged daughter rushed in with an older male cat for neuter. An "orange" cat that resembled the other one I wrote about last time. The same colour. That one bit the mother's hand while the mother was preventing him from the stray cat.
As time is precious to Singaporeans, I told the mum to go to Toa Payoh Hub with her daughter (school holidays) for one hour and come back instead of going home and come back again. She lived in Simei which is around a 30-minute drive away. "There are other clinics nearby your condo," I said. For some reason, she preferred Toa Payoh Vets and I was quite surprised.
"319074" was the postal code I had given to her when her daughter phoned the Surgery for the "pin number" as her driver mother could not locate my surgery. Nowadays, it is so easy if you have the GPS to locate places.
ANAESTHESIA
Weight: 5 kg
Xylazine 0.15ml + Ketamine 0.6 ml = 0.7 ml IM in one syringe.
Waited 10 minutes. Needed isoflurane gas 5% top up for less than 30 seconds. This shows that the dosage is a bit low for 5-kg cat. Should be xylazine 0.2 ml + Ketamine 0.8 ml without the need of topping up with isoflurane gas.
I ensured that whole scrotal and surrounding area has been plucked clean by Min and showed him how it could be done. Cleaned up scrotal area. Horizontal cut exposed two testicles. Removed them. Washed away the blood. When the owner came 2 hours later, the horizontal would appears to close together, so no bleeding or wound is seen. I asked Nicole to take a video and to record oral instructions of post-neuter care for video production. Hope this will turn out very interesting.
I asked my assistant Nicole to take some pictures to prepare a video on how to care for the cat after neutering. I had a rare case of a male cat's scrotal wound not healing some 14 days after neuter by Vet 1. So, these two cases would be able to illustrate the educational video on "post op care after neutering."
"You need to be a good story teller to connect with the audience viewing your video," I said to Nicole. "A good story is usually one where the viewer wants to know what's happen to the protagonist. For example, the video of FIV in a stray cat done by the two Temasek Polytechnic Vet Tech students. Do you find it engaging?"
"Yes," she said.
"Now, if you produce a video of 100 FIV cats with all their diseases, would that make it an interesting education video on FIV in cats?"
"No," she agreed.
"Similarly for the video on Caesarean sections produced by you for the 'Responsible Pet Ownership' video. There is no connection showing many picures of the dog and puppies after Caesarean section in the video. I would have shown the Maltese about to go under the Caesarean section. What happened to her. Did she give birth or not? Were all puppies alive? What happened next? Instead, several images of other dams and puppies after Caesarean sections were in the video."
I give free rein to the young ones to be hands on in producing the videos and that is how they learn. If I spoon-feed, they learn nothing.
A mother and her teenaged daughter rushed in with an older male cat for neuter. An "orange" cat that resembled the other one I wrote about last time. The same colour. That one bit the mother's hand while the mother was preventing him from the stray cat.
As time is precious to Singaporeans, I told the mum to go to Toa Payoh Hub with her daughter (school holidays) for one hour and come back instead of going home and come back again. She lived in Simei which is around a 30-minute drive away. "There are other clinics nearby your condo," I said. For some reason, she preferred Toa Payoh Vets and I was quite surprised.
"319074" was the postal code I had given to her when her daughter phoned the Surgery for the "pin number" as her driver mother could not locate my surgery. Nowadays, it is so easy if you have the GPS to locate places.
ANAESTHESIA
Weight: 5 kg
Xylazine 0.15ml + Ketamine 0.6 ml = 0.7 ml IM in one syringe.
Waited 10 minutes. Needed isoflurane gas 5% top up for less than 30 seconds. This shows that the dosage is a bit low for 5-kg cat. Should be xylazine 0.2 ml + Ketamine 0.8 ml without the need of topping up with isoflurane gas.
I ensured that whole scrotal and surrounding area has been plucked clean by Min and showed him how it could be done. Cleaned up scrotal area. Horizontal cut exposed two testicles. Removed them. Washed away the blood. When the owner came 2 hours later, the horizontal would appears to close together, so no bleeding or wound is seen. I asked Nicole to take a video and to record oral instructions of post-neuter care for video production. Hope this will turn out very interesting.
I asked my assistant Nicole to take some pictures to prepare a video on how to care for the cat after neutering. I had a rare case of a male cat's scrotal wound not healing some 14 days after neuter by Vet 1. So, these two cases would be able to illustrate the educational video on "post op care after neutering."
"You need to be a good story teller to connect with the audience viewing your video," I said to Nicole. "A good story is usually one where the viewer wants to know what's happen to the protagonist. For example, the video of FIV in a stray cat done by the two Temasek Polytechnic Vet Tech students. Do you find it engaging?"
"Yes," she said.
"Now, if you produce a video of 100 FIV cats with all their diseases, would that make it an interesting education video on FIV in cats?"
"No," she agreed.
"Similarly for the video on Caesarean sections produced by you for the 'Responsible Pet Ownership' video. There is no connection showing many picures of the dog and puppies after Caesarean section in the video. I would have shown the Maltese about to go under the Caesarean section. What happened to her. Did she give birth or not? Were all puppies alive? What happened next? Instead, several images of other dams and puppies after Caesarean sections were in the video."
I give free rein to the young ones to be hands on in producing the videos and that is how they learn. If I spoon-feed, they learn nothing.
759. Health screening for an 8-year-old Silkie
"You have got your money's worth today," I said to the strict-looking wife as my assistant expressed more than 5 ml of road-tarry grey granular oil from the 8-year-old solid body male neutered Silkie Terrier. "For the past 8 years, no groomer or vet had expressed his anal glands and the normally light yellow oil had turned grey. I am surprised that the dog had not bitten his tail or his backside."
Showing what is wrong is important in vet practice. The woman in her late 30s and her taciturn husband smiled a bit. Humour is sometimes important in connecting with new clients. They were from Woodlands. The wife wanted a health check up from me and had made the appointment the day before. Vet 1 had told her that her dog suffers from Grade 1/2 heart murmurs and so she would want me to give a complete check. "The heart murmurs are confirmed," I said. "But it is not serious since your dog has no coughing or loss of energy." That was good news. "If you want X-ray to see whether the heart is enlarged and the lungs are normal, let me know." The left femoral pulse was of poor quality but I have to check again this Sunday.
"Is it necessary?" she asked.
"No," I said. "It is advised as there are no signs of heart disease.
"There are so many new practices with beautiful furnishings and furniture," I compared my older premises to such new practices and asked where she would come quite far to consult me. Many Singapoean pet owners are impressed by new clinics with their shine. "New furnishings are not important," the wife said to me. "It is the vet's experience."
PHYSICAL EXAM - normal despite complaint of the dog turning his neck to the side sometimes. A painful throat but the dog disallowed mouth opening. He would twist and turn whenever I tried to pry open his mouth. "I will check for infection or tumours of the tonsils and the back of the throat during dental next week," I recorded this finding.
BLOOD TEST - ALT increase double the higher range. Liver or muscle damage but this will need another test.
URINE TEST - "Not a chance that my dog had peed this morning," the wife said to me. "We watched him closely and brought him straight to you from Woodlands." Yet when I passed a urinary cathether into the small bladder, I could get around 10 ml of urine. Why?
Results - Bacteria 3+, protein trace, bilirubin +, SG high, pH 6.5, casts but no urinary crystals. Only the bacteria count was considered significant.
"Your dog may have cystitis - a bladder infection," I said to the wife by phone. The dog was neutered very young at 8 months and his belly and neck were pigmented due to scratching. As to the cause of this black skin pigmentation, it is hard to say but it resulted from skin scratching over a long time of years.
"Does he need antibiotics?" she asked.
"I did give you some baytril tablets 2 days ago for dental scaling, to kill off bacteria in the mouth 7 days before dental scaling," I said.
"Is my dog fit for anaesthesia since he has liver disorder?" she asked.
"The ALT enzymes are not very high and the dog has good appetite. He should be OK for anaesthesia this Sunday."
Today is Wednesday. I will do the dental scaling this Sunday. Overall, the dog has passed his health screening.
Showing what is wrong is important in vet practice. The woman in her late 30s and her taciturn husband smiled a bit. Humour is sometimes important in connecting with new clients. They were from Woodlands. The wife wanted a health check up from me and had made the appointment the day before. Vet 1 had told her that her dog suffers from Grade 1/2 heart murmurs and so she would want me to give a complete check. "The heart murmurs are confirmed," I said. "But it is not serious since your dog has no coughing or loss of energy." That was good news. "If you want X-ray to see whether the heart is enlarged and the lungs are normal, let me know." The left femoral pulse was of poor quality but I have to check again this Sunday.
"Is it necessary?" she asked.
"No," I said. "It is advised as there are no signs of heart disease.
"There are so many new practices with beautiful furnishings and furniture," I compared my older premises to such new practices and asked where she would come quite far to consult me. Many Singapoean pet owners are impressed by new clinics with their shine. "New furnishings are not important," the wife said to me. "It is the vet's experience."
PHYSICAL EXAM - normal despite complaint of the dog turning his neck to the side sometimes. A painful throat but the dog disallowed mouth opening. He would twist and turn whenever I tried to pry open his mouth. "I will check for infection or tumours of the tonsils and the back of the throat during dental next week," I recorded this finding.
BLOOD TEST - ALT increase double the higher range. Liver or muscle damage but this will need another test.
URINE TEST - "Not a chance that my dog had peed this morning," the wife said to me. "We watched him closely and brought him straight to you from Woodlands." Yet when I passed a urinary cathether into the small bladder, I could get around 10 ml of urine. Why?
Results - Bacteria 3+, protein trace, bilirubin +, SG high, pH 6.5, casts but no urinary crystals. Only the bacteria count was considered significant.
"Your dog may have cystitis - a bladder infection," I said to the wife by phone. The dog was neutered very young at 8 months and his belly and neck were pigmented due to scratching. As to the cause of this black skin pigmentation, it is hard to say but it resulted from skin scratching over a long time of years.
"Does he need antibiotics?" she asked.
"I did give you some baytril tablets 2 days ago for dental scaling, to kill off bacteria in the mouth 7 days before dental scaling," I said.
"Is my dog fit for anaesthesia since he has liver disorder?" she asked.
"The ALT enzymes are not very high and the dog has good appetite. He should be OK for anaesthesia this Sunday."
Today is Wednesday. I will do the dental scaling this Sunday. Overall, the dog has passed his health screening.
758. A dog owner asked about post-op spay care from Dr Sing
Pre-Operation Guidelines for Spaying your Dog.
. The best time to spay your female dog is 2 months after her heat and at an age over 6 months
• Schedule an appointment with your vet. A blood test to screen your dog's health is advised one day before surgery.
• Make sure your dog is healthy, eating & drinking well for the past 3 days before surgery
• Give your dog a good bath, and wash the surgery area well the day before surgery
• Your dog should not eat or drink after 10pm the day before surgery, or 12 hours before surgery to prevent vomiting and choking during anaesthesia
• Bring your dog to the vet in the morning so that you can collect it in the evening after the day surgery.
Operation Procedure
• Your dog will be weighed and examined before surgery.
Isoflurane gas anaesthesia and/or an injectable anaesthesia will be given according to your dog’s health and temperament.
• The spay operation take about 30 minutes if there are no complications like bleeding
Post-Operation Guidelines for Spaying you Dog.
Frequently Asked Questions
1. What kind of food do I give, and when can I start feeding her?
If you take your dog home on the evening of the operation, it’s best to feed your dog the next day as there will be a possibility of vomiting due to the anaesthesia.
2. When can I bathe her?
Wait at least three days before bathing your dog. Cover up the wound with a water-proof plaster before bathing.
3. When do we remove the stitches?
Some vets use dissolvable stitches which will dissolve on its own, however, the vet may instruct you to return after 14 days to remove any remaining stitches.
4. What do I do in an emergency, or if the stitches break down?
If there is minor bleeding after a stitch tears apart, bandage the wound and bring your dog back to the vet as soon as you can. In case of emergency when the intestines can be seen or there is heavy bleeding, call your vet immediately.
5. When can I take off the Elizabeth Collar?
The E-Collar must be worn for 24 hours for 10-14 days, or until the stitches are completely removed.
6. Change the plaster protecting the wound on Day 2 if the vet has used a plaster.
7. Give pain relief and other medication as advised.
. The best time to spay your female dog is 2 months after her heat and at an age over 6 months
• Schedule an appointment with your vet. A blood test to screen your dog's health is advised one day before surgery.
• Make sure your dog is healthy, eating & drinking well for the past 3 days before surgery
• Give your dog a good bath, and wash the surgery area well the day before surgery
• Your dog should not eat or drink after 10pm the day before surgery, or 12 hours before surgery to prevent vomiting and choking during anaesthesia
• Bring your dog to the vet in the morning so that you can collect it in the evening after the day surgery.
Operation Procedure
• Your dog will be weighed and examined before surgery.
Isoflurane gas anaesthesia and/or an injectable anaesthesia will be given according to your dog’s health and temperament.
• The spay operation take about 30 minutes if there are no complications like bleeding
Post-Operation Guidelines for Spaying you Dog.
Frequently Asked Questions
1. What kind of food do I give, and when can I start feeding her?
If you take your dog home on the evening of the operation, it’s best to feed your dog the next day as there will be a possibility of vomiting due to the anaesthesia.
2. When can I bathe her?
Wait at least three days before bathing your dog. Cover up the wound with a water-proof plaster before bathing.
3. When do we remove the stitches?
Some vets use dissolvable stitches which will dissolve on its own, however, the vet may instruct you to return after 14 days to remove any remaining stitches.
4. What do I do in an emergency, or if the stitches break down?
If there is minor bleeding after a stitch tears apart, bandage the wound and bring your dog back to the vet as soon as you can. In case of emergency when the intestines can be seen or there is heavy bleeding, call your vet immediately.
5. When can I take off the Elizabeth Collar?
The E-Collar must be worn for 24 hours for 10-14 days, or until the stitches are completely removed.
6. Change the plaster protecting the wound on Day 2 if the vet has used a plaster.
7. Give pain relief and other medication as advised.
Tuesday, December 6, 2011
4-month-old red poodle scratches his ears vigorously
Today, Tue Dec 6, 2011, I was surprised to see a trim couple in their late 20s all the way from Sengkang wanting to vaccinate their puppy (3rd vaccination). The puppy was bought from a groomer in Pasir Ris with scales like dandruff in the legs and ears and ear edges.
"My puppy keeps scratching her ears vigorously," the wife said. The edges of both ears had fine scales. The ear pinnae, the four legs also had lots of scales. What's the cause?
SKIN SCRAPINGS 3 AREAS
I suspect scabies. I used a new scalpel blade and scrape the skin of ear edges and the paw. No ringworm. No mites seen under the microscope.
"No mites can be seen as it is possible that the experienced groomer-breeder has had treated this puppy," I said. "The mites are deep under the skin and that is why they are so irritating as they tunnel under the skin and breed."
No proof of mites but I could demonstrate the ear scratch reflex. I rubbed the edge of the right ear and the right hind limb starts to wriggle and ready to scratch the flank and chest.
GRATE + PEN TRAINING.
The puppy was paper-trained in a confined area for the first 5 days but started accidents as the wife decided to widen the space for the puppy. "It should take 14 days of close confinement to succeed in paper training," I said. "The puppy can go inside the crate (grate+pee pan) as a toilet or living den. However, the couple bought a grate + pee pan. It worked. So good.
"My puppy keeps scratching her ears vigorously," the wife said. The edges of both ears had fine scales. The ear pinnae, the four legs also had lots of scales. What's the cause?
SKIN SCRAPINGS 3 AREAS
I suspect scabies. I used a new scalpel blade and scrape the skin of ear edges and the paw. No ringworm. No mites seen under the microscope.
"No mites can be seen as it is possible that the experienced groomer-breeder has had treated this puppy," I said. "The mites are deep under the skin and that is why they are so irritating as they tunnel under the skin and breed."
No proof of mites but I could demonstrate the ear scratch reflex. I rubbed the edge of the right ear and the right hind limb starts to wriggle and ready to scratch the flank and chest.
GRATE + PEN TRAINING.
The puppy was paper-trained in a confined area for the first 5 days but started accidents as the wife decided to widen the space for the puppy. "It should take 14 days of close confinement to succeed in paper training," I said. "The puppy can go inside the crate (grate+pee pan) as a toilet or living den. However, the couple bought a grate + pee pan. It worked. So good.
756. Adopting dog with skin disease - vet cost
I am Dr Sing. It is best to adopt a dog with no skin disease. As for vet costs, it depends on what is the cause of the skin disease and prices vary from $60 to over $200 for complicated skin disease cases.
On Mon, Dec 5, 2011 at 6:08 PM, ...@gmail.com> wrote:
I have an enquiry to make and would really appreciate if you could help. I have decided to adopt a 6 months old Shetland sheepdog and border collie mix, but the breeder told me that he has skin problems, (he thinks it is fungus) on his back. I would like to know if I should wait for the wounds to heal before adopting it or i can adopt it and bring it to the vet for a check. If I were to bring the dog for a check at your veterinary, how much would it cost, ad how long would it take for the skin problem to recover?
Thank you,
E-MAIL REPLY FROM DR SING DATED DEC 6, 2011
I am Dr Sing. It is best to adopt a dog with no skin disease. As for vet costs, it depends on what is the cause of the skin disease and prices vary from $60 to over $200 for complicated skin disease cases.
On Mon, Dec 5, 2011 at 6:08 PM, ...@gmail.com> wrote:
I have an enquiry to make and would really appreciate if you could help. I have decided to adopt a 6 months old Shetland sheepdog and border collie mix, but the breeder told me that he has skin problems, (he thinks it is fungus) on his back. I would like to know if I should wait for the wounds to heal before adopting it or i can adopt it and bring it to the vet for a check. If I were to bring the dog for a check at your veterinary, how much would it cost, ad how long would it take for the skin problem to recover?
Thank you,
E-MAIL REPLY FROM DR SING DATED DEC 6, 2011
I am Dr Sing. It is best to adopt a dog with no skin disease. As for vet costs, it depends on what is the cause of the skin disease and prices vary from $60 to over $200 for complicated skin disease cases.
Sunday, December 4, 2011
755. Sunday's interesting cases. The male cat bit the mother is neutered
Sunday's interesting cases of two male cats that got neutered
CAT NEUTER NO. 1
I was on duty in the morning of Dec 4, 2011. Bright sunshine although showers come in the afternoon. My first case was a Malay family bringing in a muscular male yellow cat with brown dots of 10 months for neuter. "I phoned yesterday for appointment at 10 am," she said. "This cat bit my mother and so I want him neutered!"
"Cats in Singapore apartments don't bite people, unlike dogs," I said. "Why would he bite your mother?"
"He was chasing away a stray cat that came to our apartment door," the lady said. "My mother grabbed him to stop him. He bit my mother's hand!"
Never interfere in fighting cats or dogs - that is the morale of the story.
NEUTER
5.5 kg. My formula is xylazine 0.1 ml + ketamine 0.4 ml IM for cats <4 kg for a female cat spay. In this male cat, the above dosage was given. It was effective even after a delay of 15 minutes as I had to vaccinate the Chihuahua who had bitten me when I visited the apartment some years ago. He was neutered and adopted by Theresa and daughter, a Myanmar family in Toa Payoh, that loves him very much. This dog was given up by another family in Mandarin Gardens as he was a handful, peeing and pooping everywhere. "Does he pee all over the apartment?" I asked. "No," the mother and daughter said. "He just goes to the toilet." This was a good ending for this naughty male dog who had put on considerable weight. As I had injected the above-mentioned cat, I informed Theresa that I had to rush and it was OK with her as she had to go to the market. She had started her employment agency business. "How's your business?" I asked her. "Not good," she said. "The MOM (Ministry of Manpower) keeps rejecting every application nowadays." There is a political shift of not granting work visas for foreigners as liberally as before since the locals are not too happy as these foreigners affected their salaries. CAT NEUTER NO. 2
A woman with a son with dark blue pierced ear studs on his left ear came with 2 cats that had been neutered and spayed 9 days ago by Vet 1. "The female cat is OK," I said. "The stitches will dissolve soon. There is one small hole due to stitch coming out but it is not a problem." She asked: "Can I bathe her? She is so smelly!". "Yes," I said. "Just put a plaster onto the wound and bathe her."
As for the male cat, there was an open hole in the right scrotal area with reddish discharge coming out. "This is very rare," I said. "I have not encountered such a case in my more than 30 years of practice." Vet surgery is always full of surprises. I said: "It could be something stuck inside the wound and that is why it is not closing. There is no pain at all when I press it. Still the cat must be sedated and the open wound examined."
"I have asked my friends and they say that cat neuter wounds usually close within a few days."
All surgeries do give rise to complications of one kind or another in some cases for all vets including some of my cases. Like infection, bleeding, pain. In this case, there was yellowish nodules coming out as I pressed the 5 mm vertical hole in the right scrotal area.
I gave the cat a very low dosage of xylazine 0.05 ml + ketamine 0.2 ml combined IM and collaborated with
Dr Vanessa to handle this case as part of my coaching program. "Put the artery forcep into the gap at 12, 3, 6 and 9 o'clock and pull out any strands of tissues." Systematically. She flushed with normal saline. I wanted the cat to go home as the owner mentioned about loose stools in both cases, since the two cats was given Clavulox for the past 9 days and I am worried that the cat would develop full diarrhoea in the Surgery. But Dr Vanessa advised keeping the cat in for observation and I was OK with it. From my experience, this wound would close after removal of debris inside. But it is wise to listen to other vets.
I phoned the owner who was at the back coffee-shop that the male cat remained in for observation. "This is my first cat," she said. "It is like first love," I said. "It is always remembered. Usually it is puppy love as we usually don't marry our first love! Have you got a first love, young man?"
The pre-teen boy who love jazz music seemed to nod his head. "But mum, you are a doggy person," the pre-teen son said to the hard-working mum who had much conferences to organise. I had more time to talk to them as Dr Vanessa handle the majority of Sunday's cases after 12 noon. It was good to see mother and the music son being close.
EYE ULCER IN THE SHIH TZU AGAIN
"The previous Shih Tzu had no eye problem," the lady in her late 30s brought back a young Shih Tzu with the right eye white red and tearing. The left eye had a central white scar but the eye white was not reddish.
I had not seen the other Shih Tzu but from what I had seen from other owners, the Shih Tzu could have less protruding eyeballs and its corneas would be pigmented and black due to irritation over time. "It is hard to say that your old Shih Tzu had no problem," I said. "Many Singapore Shih Tzu owners, in the old days, just ignored the eye problems as the Shih Tzu scratches to relieve its eye itch and pain. I would expect your Shih Tzu to have black or brown corneas unless its eyeballs were less protruding."
"You did stitch up the eyelids of both eyes some weeks ago," the lady told me. "Yes," I referred to my medical record where I illustrated two eyes. The left eye had a central ulcer which is now healed white spot of 3 mm with some blood vessels. The right eye cornea was written as "cloudy," but not ulcerated and would have healed.
Dr Vanessa put in the fluorescein strip and flushed off the green dye with a syringe of saline. There were 3 corneal opacities seen. At 3 o'clock, central and 9 o'clock but they were not stained green at all after flushing off the green dye by Dr Vanessa. "It is surprising," I said. "These ulcers are over 3 mm in diameter and yet they don't stain green as expected." The dog had been rubbing his right eye despite an e-collar of size 12. I recommended size 15 and eyelid stitching up again for 14 days. The owner wanted the dog home on the same day although I advised retaining him for a day or two.
"The solution to this case is to get the facial fold cut off by the vet," I advised. I took out the Canine Opthalmology book and showed her the operation and the illustratons in this old book.
"Your dog goes to the groomer regularly to get the fold hairs snipped but the hairs grow fast and irritate the cornea causing ulcerations. You also snip the hairs but it is not easy to do it frequently. The hair grows and the water and liquid is trapped in between the facial fold and the lower eyelid leading to itchiness."
The owner was not in favour of surgical resection of the facial fold as it cost money. It is important that the vet informs the owner of a long-term solution to the problem for Shih Tzus and Pekineses as many owners are not aware of such a solution.
CAT NEUTER NO. 1
I was on duty in the morning of Dec 4, 2011. Bright sunshine although showers come in the afternoon. My first case was a Malay family bringing in a muscular male yellow cat with brown dots of 10 months for neuter. "I phoned yesterday for appointment at 10 am," she said. "This cat bit my mother and so I want him neutered!"
"Cats in Singapore apartments don't bite people, unlike dogs," I said. "Why would he bite your mother?"
"He was chasing away a stray cat that came to our apartment door," the lady said. "My mother grabbed him to stop him. He bit my mother's hand!"
Never interfere in fighting cats or dogs - that is the morale of the story.
NEUTER
5.5 kg. My formula is xylazine 0.1 ml + ketamine 0.4 ml IM for cats <4 kg for a female cat spay. In this male cat, the above dosage was given. It was effective even after a delay of 15 minutes as I had to vaccinate the Chihuahua who had bitten me when I visited the apartment some years ago. He was neutered and adopted by Theresa and daughter, a Myanmar family in Toa Payoh, that loves him very much. This dog was given up by another family in Mandarin Gardens as he was a handful, peeing and pooping everywhere. "Does he pee all over the apartment?" I asked. "No," the mother and daughter said. "He just goes to the toilet." This was a good ending for this naughty male dog who had put on considerable weight. As I had injected the above-mentioned cat, I informed Theresa that I had to rush and it was OK with her as she had to go to the market. She had started her employment agency business. "How's your business?" I asked her. "Not good," she said. "The MOM (Ministry of Manpower) keeps rejecting every application nowadays." There is a political shift of not granting work visas for foreigners as liberally as before since the locals are not too happy as these foreigners affected their salaries. CAT NEUTER NO. 2
A woman with a son with dark blue pierced ear studs on his left ear came with 2 cats that had been neutered and spayed 9 days ago by Vet 1. "The female cat is OK," I said. "The stitches will dissolve soon. There is one small hole due to stitch coming out but it is not a problem." She asked: "Can I bathe her? She is so smelly!". "Yes," I said. "Just put a plaster onto the wound and bathe her."
As for the male cat, there was an open hole in the right scrotal area with reddish discharge coming out. "This is very rare," I said. "I have not encountered such a case in my more than 30 years of practice." Vet surgery is always full of surprises. I said: "It could be something stuck inside the wound and that is why it is not closing. There is no pain at all when I press it. Still the cat must be sedated and the open wound examined."
"I have asked my friends and they say that cat neuter wounds usually close within a few days."
All surgeries do give rise to complications of one kind or another in some cases for all vets including some of my cases. Like infection, bleeding, pain. In this case, there was yellowish nodules coming out as I pressed the 5 mm vertical hole in the right scrotal area.
I gave the cat a very low dosage of xylazine 0.05 ml + ketamine 0.2 ml combined IM and collaborated with
Dr Vanessa to handle this case as part of my coaching program. "Put the artery forcep into the gap at 12, 3, 6 and 9 o'clock and pull out any strands of tissues." Systematically. She flushed with normal saline. I wanted the cat to go home as the owner mentioned about loose stools in both cases, since the two cats was given Clavulox for the past 9 days and I am worried that the cat would develop full diarrhoea in the Surgery. But Dr Vanessa advised keeping the cat in for observation and I was OK with it. From my experience, this wound would close after removal of debris inside. But it is wise to listen to other vets.
I phoned the owner who was at the back coffee-shop that the male cat remained in for observation. "This is my first cat," she said. "It is like first love," I said. "It is always remembered. Usually it is puppy love as we usually don't marry our first love! Have you got a first love, young man?"
The pre-teen boy who love jazz music seemed to nod his head. "But mum, you are a doggy person," the pre-teen son said to the hard-working mum who had much conferences to organise. I had more time to talk to them as Dr Vanessa handle the majority of Sunday's cases after 12 noon. It was good to see mother and the music son being close.
EYE ULCER IN THE SHIH TZU AGAIN
"The previous Shih Tzu had no eye problem," the lady in her late 30s brought back a young Shih Tzu with the right eye white red and tearing. The left eye had a central white scar but the eye white was not reddish.
I had not seen the other Shih Tzu but from what I had seen from other owners, the Shih Tzu could have less protruding eyeballs and its corneas would be pigmented and black due to irritation over time. "It is hard to say that your old Shih Tzu had no problem," I said. "Many Singapore Shih Tzu owners, in the old days, just ignored the eye problems as the Shih Tzu scratches to relieve its eye itch and pain. I would expect your Shih Tzu to have black or brown corneas unless its eyeballs were less protruding."
"You did stitch up the eyelids of both eyes some weeks ago," the lady told me. "Yes," I referred to my medical record where I illustrated two eyes. The left eye had a central ulcer which is now healed white spot of 3 mm with some blood vessels. The right eye cornea was written as "cloudy," but not ulcerated and would have healed.
Dr Vanessa put in the fluorescein strip and flushed off the green dye with a syringe of saline. There were 3 corneal opacities seen. At 3 o'clock, central and 9 o'clock but they were not stained green at all after flushing off the green dye by Dr Vanessa. "It is surprising," I said. "These ulcers are over 3 mm in diameter and yet they don't stain green as expected." The dog had been rubbing his right eye despite an e-collar of size 12. I recommended size 15 and eyelid stitching up again for 14 days. The owner wanted the dog home on the same day although I advised retaining him for a day or two.
"The solution to this case is to get the facial fold cut off by the vet," I advised. I took out the Canine Opthalmology book and showed her the operation and the illustratons in this old book.
"Your dog goes to the groomer regularly to get the fold hairs snipped but the hairs grow fast and irritate the cornea causing ulcerations. You also snip the hairs but it is not easy to do it frequently. The hair grows and the water and liquid is trapped in between the facial fold and the lower eyelid leading to itchiness."
The owner was not in favour of surgical resection of the facial fold as it cost money. It is important that the vet informs the owner of a long-term solution to the problem for Shih Tzus and Pekineses as many owners are not aware of such a solution.
Friday, December 2, 2011
755. Ten ivermectin injections for a hamster with skin disease
Many lady hamster owners in Singapore are sophisticated and well educated. A lady asked if I had ivermectin for her hamster who has hair loss on the back and has been "cured" by Vet 1 near her residence with injections. Ten injections over the past few months but the problem came back. I had just performed a haemangiosarcoma surgery on her old white dwarf hamster which did not survive the surgery. The tumours were large and the cells were breaking down. Full of blood. The spinal area was invaded by the tumours. The dwarf hamster could not survive the surgery. The lady was understanding as I showed her the tumour cells and pieces taken out.
"It is ivermectin," she had the info from Vet 1. "A small drop". I don't give ivermectin by 10 injections to dwarf hamsters as I believe it is harmful as hamsters are so small. She said she would revert to her vet and asked for her hamster to be cremated.
"It is ivermectin," she had the info from Vet 1. "A small drop". I don't give ivermectin by 10 injections to dwarf hamsters as I believe it is harmful as hamsters are so small. She said she would revert to her vet and asked for her hamster to be cremated.
754. SOP - Old cocker spaniel with skin disease
Cocker Spaniel. Head wounds, whole body skin infected. Saw the vet many times. Recovered, then skin disease again. Now over 12 years old. Eye pus.
SOP
1. History. Ear canals full of pus.
2. Blood test - Total WBC high.
3. Skin checked for ringworm, mites
4. Advise ear canal surgery when the dog has recovered. But the owner usually forgets about it.
In this case, I told the owner that the originating problem was the chronic ear infections and that an ear surgery when the dog was young would have resolved much of the scratching of the neck and flanks. Floppy ears. Covered up ear canal. No ventilation. Dampness. Bacterial growth. Pus form. Ulcers inside ear canal. Very painful. Head shaking. Hind leg scratching. But no hope from medication and groomer as problem recurs.
It is hard to persuade the Singapore Cocker Spaniel owner to do ear surgery.
SOP
1. History. Ear canals full of pus.
2. Blood test - Total WBC high.
3. Skin checked for ringworm, mites
4. Advise ear canal surgery when the dog has recovered. But the owner usually forgets about it.
In this case, I told the owner that the originating problem was the chronic ear infections and that an ear surgery when the dog was young would have resolved much of the scratching of the neck and flanks. Floppy ears. Covered up ear canal. No ventilation. Dampness. Bacterial growth. Pus form. Ulcers inside ear canal. Very painful. Head shaking. Hind leg scratching. But no hope from medication and groomer as problem recurs.
It is hard to persuade the Singapore Cocker Spaniel owner to do ear surgery.
753. SOP - Gangrene in an old dog's tail
The dog cut his tail spirally with a wound of 10 cm long. There was a lot of bleeding. Vet 1 stitched up and the dog went home after 4 days of being warded and cared for at Toa Payoh Vets. Gangrene developed lower down the tail. The dog had fever. The owner phoned me. What to do?
1. General examination
2. Complete blood test
3. At least 2 days of antibiotics and NSAID
4. Observe dog's appetite
5. Blood test before surgery is advised to check total WBC.
6. Isoflurane gas + O2 only at 1-2% intubated. IV drip.
7. Use electro-surgery
8. Amputate higher up to avoid gangrenous toxic tissues.
9. Post-op to stay in Toa Payoh Vets unless the owner insists on going home.
TIP. Many Singaporean dog owners have no time or are bitten when they try to clean the wound post-stitching. The e-collar worn did not prevent the dog from traumatising the tail due to pain. A long black area of the tail of more than 10 cm long developed. Gangrene. Dog had high total WBC when I admitted it. Best advice is to amputate the tail at the first instance as the owners just can't manage to nurse. Pain-killers with NSAID are not very effective in tail wound injuries for some reasons. So, I do advise tail amputation and have never received any unhappiness. In private practice, a good clinical outcome is what the owner wants. No repeat visits as this means spending more money at the vet.
1. General examination
2. Complete blood test
3. At least 2 days of antibiotics and NSAID
4. Observe dog's appetite
5. Blood test before surgery is advised to check total WBC.
6. Isoflurane gas + O2 only at 1-2% intubated. IV drip.
7. Use electro-surgery
8. Amputate higher up to avoid gangrenous toxic tissues.
9. Post-op to stay in Toa Payoh Vets unless the owner insists on going home.
TIP. Many Singaporean dog owners have no time or are bitten when they try to clean the wound post-stitching. The e-collar worn did not prevent the dog from traumatising the tail due to pain. A long black area of the tail of more than 10 cm long developed. Gangrene. Dog had high total WBC when I admitted it. Best advice is to amputate the tail at the first instance as the owners just can't manage to nurse. Pain-killers with NSAID are not very effective in tail wound injuries for some reasons. So, I do advise tail amputation and have never received any unhappiness. In private practice, a good clinical outcome is what the owner wants. No repeat visits as this means spending more money at the vet.
752. SOP for hind lameness for an adult dog
Yesterday, Dec 1, 2011 at 7 pm, a lady in her late 20s came with a 13-year-old Jack Russell. "He is better today," she said to me as I was at the reception counter. I could see the unique make up of a certain airline cabin crew and enquired whether she was from the airline. I said: "Hair in a bun and clipped, as slim as can be, a gait with confidence and a type of facial make up that never fails to attract attention."
"It is called ghost make-up," she was surprised that I could guess correctly her profession. Well, I do to see these slim and pale-looking ladies with blue eye shadows at the Singapore Changi Airport going to work or coming home. I did not realise that they look like "ghosts" until she told me.
In the consultation room, I did the examination with Dr Vanessa. A right hind lameness was the presenting sign. The dog's right paw was barely touching the floor. "This lameness has been going on for many years," she said. Other vets had examined it. I asked Dr Vanessa to do first and then I demonstrated my approach.
The Standard Operating Procedure.
1. History of lameness & general examination including teeth.
2. Observation of gait on the floor
3. Put the dog on the examination table. Muzzle the dog.
4. Palpation of spinal column. No pain/painful? Where?
5. Manipulations - dog standing (extend both hind legs and compare the length*). Put dog on side (left, right, upside down).
This is where I have to demonstrate. Basically, it is palpation, extension, flexion, abduction and adduction. Check patellar luxation.
*Put thumb on hip joint, extend hip, and knee of both limb while the dog stands on front legs. Show the owner the unequal length of the hind limb (if there is subluxation).
6. X-rays (2 views) if necessary. Arthritis, Legg-Perthe Disease, Subluxation, luxation of the right hind compared to the left hind hip.
7. Complete blood test to check for liver or kidney disease is recommended as lameness in 13-year-old Jack Russells may be caused by other reasons.
8. Costs to be made known to the owner.
"It is called ghost make-up," she was surprised that I could guess correctly her profession. Well, I do to see these slim and pale-looking ladies with blue eye shadows at the Singapore Changi Airport going to work or coming home. I did not realise that they look like "ghosts" until she told me.
In the consultation room, I did the examination with Dr Vanessa. A right hind lameness was the presenting sign. The dog's right paw was barely touching the floor. "This lameness has been going on for many years," she said. Other vets had examined it. I asked Dr Vanessa to do first and then I demonstrated my approach.
The Standard Operating Procedure.
1. History of lameness & general examination including teeth.
2. Observation of gait on the floor
3. Put the dog on the examination table. Muzzle the dog.
4. Palpation of spinal column. No pain/painful? Where?
5. Manipulations - dog standing (extend both hind legs and compare the length*). Put dog on side (left, right, upside down).
This is where I have to demonstrate. Basically, it is palpation, extension, flexion, abduction and adduction. Check patellar luxation.
*Put thumb on hip joint, extend hip, and knee of both limb while the dog stands on front legs. Show the owner the unequal length of the hind limb (if there is subluxation).
6. X-rays (2 views) if necessary. Arthritis, Legg-Perthe Disease, Subluxation, luxation of the right hind compared to the left hind hip.
7. Complete blood test to check for liver or kidney disease is recommended as lameness in 13-year-old Jack Russells may be caused by other reasons.
8. Costs to be made known to the owner.
750. SOP - Post-purchase exam of a mini-Maltese
Yesterday, Dec 1, 2011, a mother and young daughter came specifically to see me with a newly purchased mini-Maltese. She was given 24 hours for vet examination of this Maltese which cost $1,500.
I did the case with Dr Vanessa as I want to standardise the procedures in the post-purchase examination at Toa Payoh Vets to ensure a high standard of care and medical recording. Basically to be able to defend the practice in the event of litigation and complaint investigation.
As in the medical profession, each doctor has his or her own approach to post-purchase exam of a puppy. I want to make sure that Toa Payoh Vets' approach cover the bases and be able to be defended in the event of litigation and this is where I have to implement the Standard Operating Procedures (SOP). In equine medicine pre-purchase examination, the SOP is quite well defined but I don't find them commonly available in canine medicine.
The SOP is as follows:
1. Use the General Examination form and fill up the details of examination of the major body systems. Dates of the 3 vaccinations to be recorded. The vet is to be meticulous in doing the examination and recording all questions asked in the form and write remarks/comments. He or she is to sign and date the form. One copy for the owner and one copy to be kept at Toa Payoh Vets in the medical case file.
2. Do a Parvoviral test. This is mandatory for Toa Payoh Vets as parvoviral infections are common in breeders and pet shops.
3. Other tests are optional and must be explained to the owner. This includes complete blood tests, urine test, faecal test, ultrasound and X-rays whenever necessary.
4. Record house-training technique of new puppy - paper-training or grate training. The vet is to advise if he or she is able to do so. Most first-time owners appreciate this advice but not all vets can advise as it is a more complicated subject and needs reading up first.
5. Inform the owner that the Seller may have given medication to the puppy to suppress coughing (Kennel cough) and it will take at least 7 days to know if the puppy has viral and bacterial infections acquired at the Seller's premises.
I did the case with Dr Vanessa as I want to standardise the procedures in the post-purchase examination at Toa Payoh Vets to ensure a high standard of care and medical recording. Basically to be able to defend the practice in the event of litigation and complaint investigation.
As in the medical profession, each doctor has his or her own approach to post-purchase exam of a puppy. I want to make sure that Toa Payoh Vets' approach cover the bases and be able to be defended in the event of litigation and this is where I have to implement the Standard Operating Procedures (SOP). In equine medicine pre-purchase examination, the SOP is quite well defined but I don't find them commonly available in canine medicine.
The SOP is as follows:
1. Use the General Examination form and fill up the details of examination of the major body systems. Dates of the 3 vaccinations to be recorded. The vet is to be meticulous in doing the examination and recording all questions asked in the form and write remarks/comments. He or she is to sign and date the form. One copy for the owner and one copy to be kept at Toa Payoh Vets in the medical case file.
2. Do a Parvoviral test. This is mandatory for Toa Payoh Vets as parvoviral infections are common in breeders and pet shops.
3. Other tests are optional and must be explained to the owner. This includes complete blood tests, urine test, faecal test, ultrasound and X-rays whenever necessary.
4. Record house-training technique of new puppy - paper-training or grate training. The vet is to advise if he or she is able to do so. Most first-time owners appreciate this advice but not all vets can advise as it is a more complicated subject and needs reading up first.
5. Inform the owner that the Seller may have given medication to the puppy to suppress coughing (Kennel cough) and it will take at least 7 days to know if the puppy has viral and bacterial infections acquired at the Seller's premises.
749. Cataract surgery in undeveloped countries
This is the operation performed by Dr Sanduk Ruit.
http://www.youtube.com/watch?v=5nnQDscK7SI
Can this be done on dogs as presently it costs over S$3000 to do a cataract removal in an aged dog in Singapore?
http://www.youtube.com/watch?v=5nnQDscK7SI
Can this be done on dogs as presently it costs over S$3000 to do a cataract removal in an aged dog in Singapore?
Monday, November 28, 2011
748. Verrucca
There was a suspicious growing brown growth on my left chest. It was around 0.5 x0.5 cm x 0.2cm. As I do advise pet owners to get growths removed when they are small, esp. for older pets, I practise what I preach. So, today, Monday, Nov 28, 2011, at 7.15 am, I was at the Ambulatory Surgical Centre of the Singapore General Hospital to remove "verrucca" as stated by my surgeon. Last week, I saw a nurse from China googling when I was sent to the room to receive financial conselling. This is compulsory for all. "What are you googling?" I asked the friendly nurse who had seen me before for a synovial cyst excision on my right thumb. "Just to check the spelling of verrucca what Dr Foo wrote," she said. I was impressed with the thirst for knowledge imparted to the nurses.
On the surgical table, I asked Dr Foo whether he could remove the many red growths, as if blood vessels had burst. One young nurse told me: "In China, your many red spots on the man's skin are signs of good fortune." No wonder I am still alive.
I had a blood pressure monitoring arm band on my left forearm which expanded at regular intervals, giving readings in red.Another nurse who monitored my blood pressure asked if I have been active exercising. "Low pulse rate? Is it good or bad?" I asked the nurse. Low heart rate seems to be uncommon for senior citizens as I had been asked this question in another surgery. "I don't think Dr Sing exercises at all," Dr Foo commented correctly.
The carbon dioxide laser machine came into the room. I had multiple warts on my upper chest and so this machine would be useful. The nurse swabbed my upper chest with some liquid. Then Dr Foo got a purple marker pen to circle the verrucca or warts. "How many warts do you mark?" I asked Dr Foo. "Eleven. I am injecting local anaesthetic," he said. "It may be painful."
My eyes were covered by a piece of wet swab to prevent the bright operating lights blinding me. So I could not see what was going on as the laser buzzed. I could feel slight pain in some and none in other wart removal areas. A whiff of BBQ smoke pased my nostril. Soon, it was over. 3 samples of growths were taken for histopathology. The red one which was said to be a haemangioma and would recur when removed. A brown wart. Dr Foo said to the two young cheerful nurses from China: "Take the one rounded brown growth Dr Sing was worried about for the lab." I thanked him. "It could be an accessory nipple," he said of the brown growth near my armpit. "It is on the line," Dogs do have 5 pairs of nipples and well I knew what he was talking about.
Overall, it was a pleasant and enjoyable experience at the operating theatre. The bright yellow Crocs clogs were outstanding in two nurses. The others wore blue, green and black coloured ones. One man wore white boots. The cream0white vinyl tiled floor with red square patterns was very clean and shiny. There were 6 operating theatres. I could not understand why the large word "WASH" was pasted on the stainless steel sink where the surgeons scrubbed up and washed their hands pre-surgery. I saw one surgeon putting on a cloth glove and two more pairs of latex surgical gloves. "Some surgeons are allergic," the kind nurse explained to me.
On the surgical table, I asked Dr Foo whether he could remove the many red growths, as if blood vessels had burst. One young nurse told me: "In China, your many red spots on the man's skin are signs of good fortune." No wonder I am still alive.
I had a blood pressure monitoring arm band on my left forearm which expanded at regular intervals, giving readings in red.Another nurse who monitored my blood pressure asked if I have been active exercising. "Low pulse rate? Is it good or bad?" I asked the nurse. Low heart rate seems to be uncommon for senior citizens as I had been asked this question in another surgery. "I don't think Dr Sing exercises at all," Dr Foo commented correctly.
The carbon dioxide laser machine came into the room. I had multiple warts on my upper chest and so this machine would be useful. The nurse swabbed my upper chest with some liquid. Then Dr Foo got a purple marker pen to circle the verrucca or warts. "How many warts do you mark?" I asked Dr Foo. "Eleven. I am injecting local anaesthetic," he said. "It may be painful."
My eyes were covered by a piece of wet swab to prevent the bright operating lights blinding me. So I could not see what was going on as the laser buzzed. I could feel slight pain in some and none in other wart removal areas. A whiff of BBQ smoke pased my nostril. Soon, it was over. 3 samples of growths were taken for histopathology. The red one which was said to be a haemangioma and would recur when removed. A brown wart. Dr Foo said to the two young cheerful nurses from China: "Take the one rounded brown growth Dr Sing was worried about for the lab." I thanked him. "It could be an accessory nipple," he said of the brown growth near my armpit. "It is on the line," Dogs do have 5 pairs of nipples and well I knew what he was talking about.
Overall, it was a pleasant and enjoyable experience at the operating theatre. The bright yellow Crocs clogs were outstanding in two nurses. The others wore blue, green and black coloured ones. One man wore white boots. The cream0white vinyl tiled floor with red square patterns was very clean and shiny. There were 6 operating theatres. I could not understand why the large word "WASH" was pasted on the stainless steel sink where the surgeons scrubbed up and washed their hands pre-surgery. I saw one surgeon putting on a cloth glove and two more pairs of latex surgical gloves. "Some surgeons are allergic," the kind nurse explained to me.
747. The tu tu kueh woman's dog
Yesterday was a long day at work on a Sunday. I usually work half a day and let Dr Vanessa do the rest. I asked Mr Min to take the afternoon off and so I stayed around and stayed to do some administration. A practice needs to be administered well or it will just suffocate and wither as the world is getting complex and competitive. The clients are getting sophisticated and more demanding.
For example, one client wanted me to excise a large paw haematoma without sedatives as she was afraid that her old pug would die under sedation. That is a valid fear. To do it or not? It is up to the vet. The vet can just reject her case. What if the old pug dies under sedation? And nobody can predict this. For the sake of the old pug, I incised the haematoma and let it was OK.
The tu tu kueh woman at Bishan Shopping Mall. She asked what stall I was managing as she had seen me so many times over the years buying tu tu kueh from her and asking about her work. She had cooked soup which was shared with other woman stall holders and her brother who sold cakes under the same boss. When I told her I am a vet, she said: "I cried a long time when my dog died. Just running nose. A lot of it. My friend sent it to a vet. Some injection. Hospitalised for 2 days. My dog died. Just runny nose. Goes to the vet. Injection. Died."
"There could be many reasons," I said. "It could be a drug allergy. It could be a serious infection. How old and what breed?"
"7 years old. A Pomeranian." Her eyes teared up as she remembered her dog so well.
Now this dog was a clever dog. "My dog would jump and greet me when I unlock the apartment door. He could hear my key sound. When other family members unlock the door, my door would ignore them," she said, turning her head sideways.
"When I stayed too late watching TV, my dog would lick my ears to ask me to sleep. If I did not, he would jump to obstruct the TV screen."
"That sounds like a very intelligent dog," I was surprised. "It is as if he was a very caring human being re-incarnated as a dog." Some religions believe in re-incarnation and this canine story seems to support this.
If I can find a small breed to be rehomed, I will get one for her as she cares so much for dogs.
For example, one client wanted me to excise a large paw haematoma without sedatives as she was afraid that her old pug would die under sedation. That is a valid fear. To do it or not? It is up to the vet. The vet can just reject her case. What if the old pug dies under sedation? And nobody can predict this. For the sake of the old pug, I incised the haematoma and let it was OK.
The tu tu kueh woman at Bishan Shopping Mall. She asked what stall I was managing as she had seen me so many times over the years buying tu tu kueh from her and asking about her work. She had cooked soup which was shared with other woman stall holders and her brother who sold cakes under the same boss. When I told her I am a vet, she said: "I cried a long time when my dog died. Just running nose. A lot of it. My friend sent it to a vet. Some injection. Hospitalised for 2 days. My dog died. Just runny nose. Goes to the vet. Injection. Died."
"There could be many reasons," I said. "It could be a drug allergy. It could be a serious infection. How old and what breed?"
"7 years old. A Pomeranian." Her eyes teared up as she remembered her dog so well.
Now this dog was a clever dog. "My dog would jump and greet me when I unlock the apartment door. He could hear my key sound. When other family members unlock the door, my door would ignore them," she said, turning her head sideways.
"When I stayed too late watching TV, my dog would lick my ears to ask me to sleep. If I did not, he would jump to obstruct the TV screen."
"That sounds like a very intelligent dog," I was surprised. "It is as if he was a very caring human being re-incarnated as a dog." Some religions believe in re-incarnation and this canine story seems to support this.
If I can find a small breed to be rehomed, I will get one for her as she cares so much for dogs.
Sunday's interesting cases - Nov 27, 2011
1. Septicaemia from gangrenous vaginal hyperplasia and prolapse
The Chihuahua passed away after heavy panting. I had a complete blood test done 2 days ago and had informed the owners that the dog had toxic blood. The total white cell count was twice as high as the higher range, the red cells were twice as low as the lower range and the platelet count was very low at 14. Urine analysis showed bacteria and blood (estrus). I noted that her tongue was purplish and that was not a good sign as it indicated some abnormality of health. The blood test was indicative of a septicaemia.
"After two days, the tip of the vagina prolapse became black," the caregiver mum told me over the phone. That was when she consulted Vet 1. The dog stopped eating and was treated but the blackness at the tip spread more. If this was a gangrenous tail tip, it could be amputated. But this was part of the vaginal mucosa. In any case, anaesthesia and surgery of a dog that is not eating and has a lower than normal rectal temperature (37.6 in the first 2 days) was highly risky. The dog was spayed and survived the operation for 4 days. The Chihuahua was 10 years old and was in good bodily condition.
It is important that a blood test is taken when necessary two days after the surgery as septicaemia is an on-going process. The earlier blood test did not show serious changes. In the event of a bad outcome, the owner and all family members will like answers as to the cause of death. Evidence-based medicine using blood test provided the answer.
2. The dog with a gangrenous tail. "It is important that the owners, you and I meet together in the consultation room to discuss about her case," I said to Dr Vanessa who had stitched up a serious profuse bleeding tail wound and had sent the dog home with an e-collar and medication 3 days after surgery. "I had spoken to the owner," Dr Vanessa said. However, I had promised the owner to have a joint meeting as it is hard for me to listen to one side of the story - her side and Dr Vanessa's side and advise. "This joint meeting in my presence is important to clear any misunderstanding," I said to Dr Vanessa. "The owners have not been happy with the dog developing a tail gangrene after surgery. This meeting is not to find blame on the vet. Such misunderstandings from the owners do happen to all vets after surgery, including myself. It is best to meet jointly and clear up all emotional unhappiness."
"I don't blame Dr Vanessa," the owner said first.
"From my experience with tail wound cases, it is usually the dog that traumatises the wound, causing it to become infected and gangrenous. That is why I normally advise tail amputation in serious wound cases as the owner does not know how to take care of it after surgery. However, some owners don't like this idea and want the tail to be saved. In your dog, the tail would be hammered by the end of the e-collar to relieve its pain and itchiness."
"The dog bites me when I try to clean the tail," the lady owner said. "Yet at Toa Payoh Vets, the dog lets the vet change bandage without biting! He uses the e-collar to scratch the tail. The wound opens up. Yellow pus is seen. I phoned Dr Vanessa but she did not answer the call. That is why I phoned you."
"I got a phone call after midnight," Dr Vanessa said.
"Was the tail gangrenous when the dog went home 3 days after surgery?" I asked.
"No," the owner said.
"Many times, the unhappiness is due to financial reasons," I shared my experiences with Dr Vanessa. "You attempted to save the severely lacerated tail by stitching and controlling the bleeding. You sent the dog home 3 days after surgery but the dog can't stand the pain and itch despite your NSAID medication. So, he bites the owner trying to change the bandage. The tail gets infected and gangrenous. Now the owner has to spend more money to get the tail amputated.
"That is why I always advise tail amputation of a seriously wounded tail as the first choice. If the owner declined and the tail becomes gangrenous, there is no unhappiness. You had done on in a cat some time ago when the owner accepted my advice. Have you seen any return of the owner?"
"No," Dr Vanessa said.
"As a vet, we try to salvage the tail. As the vast majority of owners cannot do post-op nursing, the tail becomes gangrenous and this is stressful and expensive for the owner.
The Chihuahua passed away after heavy panting. I had a complete blood test done 2 days ago and had informed the owners that the dog had toxic blood. The total white cell count was twice as high as the higher range, the red cells were twice as low as the lower range and the platelet count was very low at 14. Urine analysis showed bacteria and blood (estrus). I noted that her tongue was purplish and that was not a good sign as it indicated some abnormality of health. The blood test was indicative of a septicaemia.
"After two days, the tip of the vagina prolapse became black," the caregiver mum told me over the phone. That was when she consulted Vet 1. The dog stopped eating and was treated but the blackness at the tip spread more. If this was a gangrenous tail tip, it could be amputated. But this was part of the vaginal mucosa. In any case, anaesthesia and surgery of a dog that is not eating and has a lower than normal rectal temperature (37.6 in the first 2 days) was highly risky. The dog was spayed and survived the operation for 4 days. The Chihuahua was 10 years old and was in good bodily condition.
It is important that a blood test is taken when necessary two days after the surgery as septicaemia is an on-going process. The earlier blood test did not show serious changes. In the event of a bad outcome, the owner and all family members will like answers as to the cause of death. Evidence-based medicine using blood test provided the answer.
2. The dog with a gangrenous tail. "It is important that the owners, you and I meet together in the consultation room to discuss about her case," I said to Dr Vanessa who had stitched up a serious profuse bleeding tail wound and had sent the dog home with an e-collar and medication 3 days after surgery. "I had spoken to the owner," Dr Vanessa said. However, I had promised the owner to have a joint meeting as it is hard for me to listen to one side of the story - her side and Dr Vanessa's side and advise. "This joint meeting in my presence is important to clear any misunderstanding," I said to Dr Vanessa. "The owners have not been happy with the dog developing a tail gangrene after surgery. This meeting is not to find blame on the vet. Such misunderstandings from the owners do happen to all vets after surgery, including myself. It is best to meet jointly and clear up all emotional unhappiness."
"I don't blame Dr Vanessa," the owner said first.
"From my experience with tail wound cases, it is usually the dog that traumatises the wound, causing it to become infected and gangrenous. That is why I normally advise tail amputation in serious wound cases as the owner does not know how to take care of it after surgery. However, some owners don't like this idea and want the tail to be saved. In your dog, the tail would be hammered by the end of the e-collar to relieve its pain and itchiness."
"The dog bites me when I try to clean the tail," the lady owner said. "Yet at Toa Payoh Vets, the dog lets the vet change bandage without biting! He uses the e-collar to scratch the tail. The wound opens up. Yellow pus is seen. I phoned Dr Vanessa but she did not answer the call. That is why I phoned you."
"I got a phone call after midnight," Dr Vanessa said.
"Was the tail gangrenous when the dog went home 3 days after surgery?" I asked.
"No," the owner said.
"Many times, the unhappiness is due to financial reasons," I shared my experiences with Dr Vanessa. "You attempted to save the severely lacerated tail by stitching and controlling the bleeding. You sent the dog home 3 days after surgery but the dog can't stand the pain and itch despite your NSAID medication. So, he bites the owner trying to change the bandage. The tail gets infected and gangrenous. Now the owner has to spend more money to get the tail amputated.
"That is why I always advise tail amputation of a seriously wounded tail as the first choice. If the owner declined and the tail becomes gangrenous, there is no unhappiness. You had done on in a cat some time ago when the owner accepted my advice. Have you seen any return of the owner?"
"No," Dr Vanessa said.
"As a vet, we try to salvage the tail. As the vast majority of owners cannot do post-op nursing, the tail becomes gangrenous and this is stressful and expensive for the owner.
Saturday, November 26, 2011
745. The "hidden" pup in canine Caesarean sections
http://www.sinpets.com/F5/20111126hidden-pup-caesarean-section-dog-singapore-toapayohvets.htm
has the complete story.
has the complete story.
Friday, November 25, 2011
744. Anaesthesia of old Chihuahua - vaginal hyperplasia and prolapse
Chihuahua, Female, 10 years
Active and eating well till 19.11.2011 when the owner noted a vaginal prolapsed. The dog became lethargic and did not eat. Vaginal or uterine prolapse diagnosed by Vet 1. Owner went back but the pushed back vaginal tissue came out again. Tip became black after 2 days. No e-collar worn.
22.11.11 A friend of the owner was worried and asked me to advise the owner to euthanase the Chihuahua if she was suffering from liver and kidney infections as deduced from abdominal ultrasound and blood test reports. I reviewed the case.
As the owner is not able to take care of the everted vaginal tissue and it had become necrotic, I advised spay the next day as this was the solution. But there was a high anaesthetic risk as the dog did not eat for the last 4 days and her tongue was purplish. Mild dehydration. Temperature below 38 deg C for the last 2 days.
22.11. 11 One day Pre-op IV drip and antibiotic
23.11. 11 37.6 deg, 3.5 kg.
10am
IV drip glucose 5 minutes, then dextrose saline. Tongue became pinker.
IV lasix 2 ml
Domitor 0.05 ml + Ketamine 0.05 ml IV
Isoflurane gas top up at 0.5 - 1%
I expected a 10-minute spay.
Dog vomited yellow liquid after intubation. Repeat.
Dog passed loose black stools. Cleaning up. This took time.
Opened abdomen, hooked out left ovary.
However, both the ovarian ligaments and bv ruptured when ligated. Bleeding seen. So, I had to make a large skin incision to locate the bleeder far inside, behind the kidneys. Two quail-egg sized blood clots on left and right sides were taken out. Bleeders located but bleeding was oozing now. Clamped and ligated one bleeder as the left one slipped off the kidney area. Checked and cleared all bleeding inside abdomen. Closed up 2/0 PDS sutures. Completion at 11.30 am.
Active and eating well till 19.11.2011 when the owner noted a vaginal prolapsed. The dog became lethargic and did not eat. Vaginal or uterine prolapse diagnosed by Vet 1. Owner went back but the pushed back vaginal tissue came out again. Tip became black after 2 days. No e-collar worn.
22.11.11 A friend of the owner was worried and asked me to advise the owner to euthanase the Chihuahua if she was suffering from liver and kidney infections as deduced from abdominal ultrasound and blood test reports. I reviewed the case.
As the owner is not able to take care of the everted vaginal tissue and it had become necrotic, I advised spay the next day as this was the solution. But there was a high anaesthetic risk as the dog did not eat for the last 4 days and her tongue was purplish. Mild dehydration. Temperature below 38 deg C for the last 2 days.
22.11. 11 One day Pre-op IV drip and antibiotic
23.11. 11 37.6 deg, 3.5 kg.
10am
IV drip glucose 5 minutes, then dextrose saline. Tongue became pinker.
IV lasix 2 ml
Domitor 0.05 ml + Ketamine 0.05 ml IV
Isoflurane gas top up at 0.5 - 1%
I expected a 10-minute spay.
Dog vomited yellow liquid after intubation. Repeat.
Dog passed loose black stools. Cleaning up. This took time.
Opened abdomen, hooked out left ovary.
However, both the ovarian ligaments and bv ruptured when ligated. Bleeding seen. So, I had to make a large skin incision to locate the bleeder far inside, behind the kidneys. Two quail-egg sized blood clots on left and right sides were taken out. Bleeders located but bleeding was oozing now. Clamped and ligated one bleeder as the left one slipped off the kidney area. Checked and cleared all bleeding inside abdomen. Closed up 2/0 PDS sutures. Completion at 11.30 am.
743. Day 3. Vaginal hyperplasia & prolapse in the female dog - Surgical option
Day 3. The Chihuahua bites me and my assistant any time we try to catch her. She does not eat but otherwise is alert and strong. "Is the vaginal prolapse the same size?" I asked my assistant Min, as part of my coaching process. I had pushed in the prolapse yesterday morning.
"Same as before," Min said. "Come out again." He could have difficulty understanding Singapore English as he is not proficient in this language.
He tried to muzzle the dog for me to examine. The dog snapped at him. I had taught him to use a towel to cover the dog's head but he did not do it this time. It needs lots of patience to train a person. I covered the dog's head with a towel. The dog moved to a corner. "Use a leash to lasso her," I said. Otherwise it is impossible to examine her. Min held the leash and lifted up the tail. The dog moved but could not bite us.
The prolapsed vagina had decreased by 60% in size. I was not surprised as spaying removed the oestrogen causing this problem. Min saw the size and that is important. I pushed it in. The dog should be able to go home soon as she is not eating here. I did advise a 20-ml syringe to feed her. A 2-ml syringe with canned food is too short.
"Same as before," Min said. "Come out again." He could have difficulty understanding Singapore English as he is not proficient in this language.
He tried to muzzle the dog for me to examine. The dog snapped at him. I had taught him to use a towel to cover the dog's head but he did not do it this time. It needs lots of patience to train a person. I covered the dog's head with a towel. The dog moved to a corner. "Use a leash to lasso her," I said. Otherwise it is impossible to examine her. Min held the leash and lifted up the tail. The dog moved but could not bite us.
The prolapsed vagina had decreased by 60% in size. I was not surprised as spaying removed the oestrogen causing this problem. Min saw the size and that is important. I pushed it in. The dog should be able to go home soon as she is not eating here. I did advise a 20-ml syringe to feed her. A 2-ml syringe with canned food is too short.
741. Severe tail injury - the sole option -- tail amputation
"There is only one option when the dog or cat suffers serious injury to its tail," I said to my associate vet who had stitched up the slanting tail laceration wound of more than 6 cm long and sent the dog home with e-collar and medication.
"Based on my past 30 years experience, many Singaporean dog and cat owners are not able to nurse their dog's tail wounds. Even with e-collars, the dog or cat hits the injured irritating tail, causing more damage. The tail does not heal and becomes gangrenous. The owner becomes upset as she had already spent money on this first surgical treatment. It is not working and now the owner is upset."
"In all tail injury cases, the owner must be advised firmly and in writing that tail amputation is the sole option as gangrene is likely to set in, with stitching and other bandaging. There was a case of a cat with tail injury. I advised tail amputation. We don't see any complaint post-op. Now, this case comes back with lots of unhappiness as the tail becomes blackened and the tip has become cold."
As the owner was unhappy with the outcome, I advise that she and the operating vet and myself meet at the same time to discuss the matter. It is best done that way than individuals giving their points of view to me one-on-one basis.
The outcome of a case of tail injury is very important to the owner. The owner wants just one visit and not be inconvenienced by having repeat treatment. "Even with gushing blood and copious bleeding, ligate the tail blood vessel, bandage the tail and amputate the tail 2 days later."
"Based on my past 30 years experience, many Singaporean dog and cat owners are not able to nurse their dog's tail wounds. Even with e-collars, the dog or cat hits the injured irritating tail, causing more damage. The tail does not heal and becomes gangrenous. The owner becomes upset as she had already spent money on this first surgical treatment. It is not working and now the owner is upset."
"In all tail injury cases, the owner must be advised firmly and in writing that tail amputation is the sole option as gangrene is likely to set in, with stitching and other bandaging. There was a case of a cat with tail injury. I advised tail amputation. We don't see any complaint post-op. Now, this case comes back with lots of unhappiness as the tail becomes blackened and the tip has become cold."
As the owner was unhappy with the outcome, I advise that she and the operating vet and myself meet at the same time to discuss the matter. It is best done that way than individuals giving their points of view to me one-on-one basis.
The outcome of a case of tail injury is very important to the owner. The owner wants just one visit and not be inconvenienced by having repeat treatment. "Even with gushing blood and copious bleeding, ligate the tail blood vessel, bandage the tail and amputate the tail 2 days later."
Thursday, November 24, 2011
741. Keratitis in pugs and people
Keratitis is an inflammation of the cornea. In people wearing soft contact lens, there are 3 types of keratitis:
1. Infective Keratitis. Cornea inflammation caused by micro-organisms like baceria, fungi and parasites. Can lose eye-sight if not treated early or by appropriate antibiotics. Cloudy scar on cornea when healed. A person can't see clearly. Same with pugs and other dogs. Big problem in pugs and shih tzus. It is called ulcerative keratitis. See one picture below:
2. Epthelial Keratitis. The top layer of the cornea is inflamed. Small holes are seen in the epithelium. It is called punctate epithelial erosions and this is also commonly seen in pugs and shih tzus. For the dogs, it is due to traumatic injury. See the green spots of one pug's eye below:
The holes may get infected by bacterial.
3. Allergic Conjunctivitis. The membrane which is below the eyelids is called conjunctiva. An allergic reaction to the contact lens or its solution leads to eyelid swelling and pain.
Chemosis - swelling of eyelids.
PUGS, SHIH TZUS AND PEKINESE
Ulcerative Keratitis is commonly seen due to injury to the protruding eyeball. Early treatment saves the eye sight.
Many Singapore owners of the pug and shih tzu and related breeds have no time to maintain the facial folds or damage the cornea during cleaning of the facial fold. Hairs get trapped inside the eyelids and as you can see from the picture below, the cornea is deprived of oxygen by the turfs of hair and get irritated and infected by bacteria found in the hairs.
My advice is to get your vet to excise both facial folds, preventing the formation of ulceratitive keratitis. But many Singapore owners do not want to accept this advice and so, as the years pass by, the cornea becomes blackened or browned by pigments (chronic irritation for many years). The dog is practicallly blind but the owner is not personally affected. It is just so sad. Keeping the eyes of pugs, shih tzus and pekineses clear and transparent to old age is a heavy responsibility. I hope the younger google generation will be more enlightened and sophisticated to prevent such problems by early treatment at the vet or by getting the facial fold excision done.
1. Infective Keratitis. Cornea inflammation caused by micro-organisms like baceria, fungi and parasites. Can lose eye-sight if not treated early or by appropriate antibiotics. Cloudy scar on cornea when healed. A person can't see clearly. Same with pugs and other dogs. Big problem in pugs and shih tzus. It is called ulcerative keratitis. See one picture below:
2. Epthelial Keratitis. The top layer of the cornea is inflamed. Small holes are seen in the epithelium. It is called punctate epithelial erosions and this is also commonly seen in pugs and shih tzus. For the dogs, it is due to traumatic injury. See the green spots of one pug's eye below:
3. Allergic Conjunctivitis. The membrane which is below the eyelids is called conjunctiva. An allergic reaction to the contact lens or its solution leads to eyelid swelling and pain.
Chemosis - swelling of eyelids.
PUGS, SHIH TZUS AND PEKINESE
Ulcerative Keratitis is commonly seen due to injury to the protruding eyeball. Early treatment saves the eye sight.
Many Singapore owners of the pug and shih tzu and related breeds have no time to maintain the facial folds or damage the cornea during cleaning of the facial fold. Hairs get trapped inside the eyelids and as you can see from the picture below, the cornea is deprived of oxygen by the turfs of hair and get irritated and infected by bacteria found in the hairs.
My advice is to get your vet to excise both facial folds, preventing the formation of ulceratitive keratitis. But many Singapore owners do not want to accept this advice and so, as the years pass by, the cornea becomes blackened or browned by pigments (chronic irritation for many years). The dog is practicallly blind but the owner is not personally affected. It is just so sad. Keeping the eyes of pugs, shih tzus and pekineses clear and transparent to old age is a heavy responsibility. I hope the younger google generation will be more enlightened and sophisticated to prevent such problems by early treatment at the vet or by getting the facial fold excision done.
--------------------------
22 Dec 2020. The lady owner of this 10-year-old male not neutered pug contacted me via text message as her pug's right eye had some "brown" thing. It was a matted cornea with ulcers and hair glued onto the cornea, on detailed examination, under sedation, in the operation room. Images are in instagram as well.
Monday, November 21, 2011
740. SOP Dental scaling at Toa Payoh Vets
The following is advised before an old dog (>5 years old) gets dental work done under general anaesthesia
1. General and detailed examination
2. Complete blood test for health screening
3. Oral antibiotics for 7 days before dental work
4. Dental work with low sedation and use of isoflurane + O2 gas
5. Post-op antibiotic and pain-killer injection
6. Post-op pain-killer and antibiotics 5 days
7. Teeth extracted to be shown to owner
8. Dental record
9. Dental reminder 2 years later
P.S. X-rays of lungs and heart ECG may need to be done
1. General and detailed examination
2. Complete blood test for health screening
3. Oral antibiotics for 7 days before dental work
4. Dental work with low sedation and use of isoflurane + O2 gas
5. Post-op antibiotic and pain-killer injection
6. Post-op pain-killer and antibiotics 5 days
7. Teeth extracted to be shown to owner
8. Dental record
9. Dental reminder 2 years later
P.S. X-rays of lungs and heart ECG may need to be done
A big thank you to the young Singaporeans who produced the following videos to educate pet owners and bring veterinary medicine and surgery alive to the vet students studying hard for their exam.
As these google-generation people are very busy and have not charged me for services, I have not asked them to edit again to make a perfect production.
The following are the videos:
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the Sec 3 St Andrew boys produced. The "owner" of the pug was the student but the other characters are genuine. The video producer was another student and his teacher had kindly recommended him to me to help in this production. It turned out to be quite fun to watch this video, in my opinion.
For example, locking the door of the black Mercedes car is not done nowadays but we all had great fun in producing this video. The "owner" seemed to be smiling when he came for a second vet visit with a puppy that had worsened in coughing! I mean, the real owner would be very worried!
After hospitalisation in a crate, there was a scene of the puppy on the consultation table inside the vet consultation room! This should be cut! This is the first video production and no more other versions. That is why I explained the "deficiencies" in the production!
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video - Nicole Pereira. Excellent summary of some of the main problems seen at Toa Payoh Vets. Great work.
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up - Temasek Polytechnic Vet Tech students who do not wish to be credited
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2 - Temasek Polytechnic Vet Tech students who do not wish to be credited
Overall, it took a lot of time. Too much time.
As these google-generation people are very busy and have not charged me for services, I have not asked them to edit again to make a perfect production.
The following are the videos:
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the Sec 3 St Andrew boys produced. The "owner" of the pug was the student but the other characters are genuine. The video producer was another student and his teacher had kindly recommended him to me to help in this production. It turned out to be quite fun to watch this video, in my opinion.
For example, locking the door of the black Mercedes car is not done nowadays but we all had great fun in producing this video. The "owner" seemed to be smiling when he came for a second vet visit with a puppy that had worsened in coughing! I mean, the real owner would be very worried!
After hospitalisation in a crate, there was a scene of the puppy on the consultation table inside the vet consultation room! This should be cut! This is the first video production and no more other versions. That is why I explained the "deficiencies" in the production!
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video - Nicole Pereira. Excellent summary of some of the main problems seen at Toa Payoh Vets. Great work.
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up - Temasek Polytechnic Vet Tech students who do not wish to be credited
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2 - Temasek Polytechnic Vet Tech students who do not wish to be credited
Overall, it took a lot of time. Too much time.
734. Educational videos produced by young Singaporeans for Toa Payoh Vets
E-MAIL FROM DR SING DATED NOV 21, 2011
Thank you very much for your help in producing the Responsible Pet video meant for the AVA Responsible Dog Ownership Road show. The KC video was also good thanks to your help. The voices of the narrators were distinct and clear, to my surprise and the narrative scenes were not boring unlike a power point presentation or a professor's lecture. I hope the vet students do learn a bit about complicated kennel cough.
I gave each party general guidelines as I want other views and presentation.
Each party brings in something new (ideas and presentation and music) in video production and that is why it is so interesting to watch them. Thanks again.
I am only worried about the microchip scanning pic and some other pic you put on the Responsible Pet Ownership video as they may be copyright. Pl confirm the source as we can get sued or get a legal warning to remove it! Pl look into this matter and it is best to remove them and put in original images.
On Sun, Nov 20, 2011 at 5:06 PM, Nicole Pereira wrote:
Hi Dr Sing, here's the links to the videos i uploaded to your 99pups account-
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the St Andrew boys produced
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2
Thank you very much for your help in producing the Responsible Pet video meant for the AVA Responsible Dog Ownership Road show. The KC video was also good thanks to your help. The voices of the narrators were distinct and clear, to my surprise and the narrative scenes were not boring unlike a power point presentation or a professor's lecture. I hope the vet students do learn a bit about complicated kennel cough.
I gave each party general guidelines as I want other views and presentation.
Each party brings in something new (ideas and presentation and music) in video production and that is why it is so interesting to watch them. Thanks again.
I am only worried about the microchip scanning pic and some other pic you put on the Responsible Pet Ownership video as they may be copyright. Pl confirm the source as we can get sued or get a legal warning to remove it! Pl look into this matter and it is best to remove them and put in original images.
On Sun, Nov 20, 2011 at 5:06 PM, Nicole Pereira
Hi Dr Sing, here's the links to the videos i uploaded to your 99pups account-
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the St Andrew boys produced
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2
Sunday, November 20, 2011
Sunday Nov 20, 2011 interesting cases
EYES
1. Pug with right eye perforated ulcer treated by me some months ago came in for annual vaccination. A young couple who remembered me as much as I remember them due to this serious eye injury drama as described in my case:
Ulcer healed very well but two very small green ulcers (fluorescein stain) seen to the 7 o'clock. Extraordinary amount of hairs clumped together on corneal surface when I cleaned it (see image). Dr Vanessa had applied the fluroescein strip and had flushed out the green dye. I took over while she checked another dog as the couple wanted to consult me.
Left eye - no ulcers but brown pigmentation covers 50$% of central area - friction from owner cleaning facial fold daily?
I advised facial fold excision as the hairs from the fold must have irritaed the corena (central area) and the pug must be rubbing the eye. "Alternative is to close the eyelids when cleaning the facial fold area," I said.
"Will the surgery affect the health of the pug?" the lady asked. "No," I said. Less itchiness and no more need to wipe the secretions off the facial fold. If irritation continues, the cornea will be seeded by brown black pigments over the years and the dog can't see clearly in front.
The owners would think about the surgery. Their other pug has no corneal ulceration problems. It is hard to foresee the future. "The facial fold is part of the pug's beauty but healthy is more important than beauty," I said.
2. CORNEAL DYSTROPHY
The miniature pinscher owner had texted to consult me yesterday to review the eye. She firmly believes that the circle of whiteness of the inside of the cornea had been reduced with the use of garasone eye drops daily with one small drop.
I will refer to the other picture I took some time ago and see. It seems that the circle has shrunk a bit and the edges are more firm. I need to review the old pic.
The left eye has some interesting developments when I view the images. The dog was fidgety and therefore no proper examination was possible. The owner did not want fluroescein eye stain test for the eyes and so I can't confirm whether the left eye still has ulcers in the upper half near the melanomas.
The pic traken toaday shows "crocodile skin" areound the eyelids. Must check previous pic soon.
CASE 3
A 13-year-old pug passed away after 11 pm yesterday. My assistant Min saw him alive and resting at 11 pm when he did his last checking.
"Why did you send a pug for grooming?" I asked the young couple who told me that the pug had never coughed once before going to the groomer two days ago (Friday). Then she coughed vigorously at home for a long time and so I was consulted on Saturday morning. The pug did not cough when I saw him. "The likely cause of coughing is due to kennel cough," I said as kennel cough is a common disease in places where dogs of various ages mix and it is a very contagious disease. The old dog had not been vaccinated forl many years. So, the primary diagnosis was kennel cough - a dry hacking cough.
I recommended to ward the old dog in a cage so she could rest. "Continuous coughing will result in blood vessel rupture in the lungs," I said to the young couple. Blood test was advised to check for infectious situation but the owners declined.
When the pug died, both her nostrils had red blood. Her tongue was cyanotic. So there was some respiratory damage and bleeding. "An independent post-mortem by the AVA will be needed to ascertain the cause of death," I said to the lady whom I phoned. "The dog is old and her immune system would be weak and she was not able to fight off the viruses and bacteria of kennel cough," I said. Cremation was arranged and the urn would be available in 2 days' time. It is one of the cases where old dogs without vaccination should not be exposed to other dogs. The pug was having her nails clipped and she panted at the pet shop. It was a sad Sunday for me as the pug had not shown any signs of impending death at the Surgery. In fact he had eaten some food after treatment with antibiotics and a drip. However, I had warned the owner of a possible death and the owners were understanding.
1. Pug with right eye perforated ulcer treated by me some months ago came in for annual vaccination. A young couple who remembered me as much as I remember them due to this serious eye injury drama as described in my case:
Ulcer healed very well but two very small green ulcers (fluorescein stain) seen to the 7 o'clock. Extraordinary amount of hairs clumped together on corneal surface when I cleaned it (see image). Dr Vanessa had applied the fluroescein strip and had flushed out the green dye. I took over while she checked another dog as the couple wanted to consult me.
Left eye - no ulcers but brown pigmentation covers 50$% of central area - friction from owner cleaning facial fold daily?
I advised facial fold excision as the hairs from the fold must have irritaed the corena (central area) and the pug must be rubbing the eye. "Alternative is to close the eyelids when cleaning the facial fold area," I said.
"Will the surgery affect the health of the pug?" the lady asked. "No," I said. Less itchiness and no more need to wipe the secretions off the facial fold. If irritation continues, the cornea will be seeded by brown black pigments over the years and the dog can't see clearly in front.
The owners would think about the surgery. Their other pug has no corneal ulceration problems. It is hard to foresee the future. "The facial fold is part of the pug's beauty but healthy is more important than beauty," I said.
2. CORNEAL DYSTROPHY
The miniature pinscher owner had texted to consult me yesterday to review the eye. She firmly believes that the circle of whiteness of the inside of the cornea had been reduced with the use of garasone eye drops daily with one small drop.
I will refer to the other picture I took some time ago and see. It seems that the circle has shrunk a bit and the edges are more firm. I need to review the old pic.
The left eye has some interesting developments when I view the images. The dog was fidgety and therefore no proper examination was possible. The owner did not want fluroescein eye stain test for the eyes and so I can't confirm whether the left eye still has ulcers in the upper half near the melanomas.
The pic traken toaday shows "crocodile skin" areound the eyelids. Must check previous pic soon.
CASE 3
A 13-year-old pug passed away after 11 pm yesterday. My assistant Min saw him alive and resting at 11 pm when he did his last checking.
"Why did you send a pug for grooming?" I asked the young couple who told me that the pug had never coughed once before going to the groomer two days ago (Friday). Then she coughed vigorously at home for a long time and so I was consulted on Saturday morning. The pug did not cough when I saw him. "The likely cause of coughing is due to kennel cough," I said as kennel cough is a common disease in places where dogs of various ages mix and it is a very contagious disease. The old dog had not been vaccinated forl many years. So, the primary diagnosis was kennel cough - a dry hacking cough.
I recommended to ward the old dog in a cage so she could rest. "Continuous coughing will result in blood vessel rupture in the lungs," I said to the young couple. Blood test was advised to check for infectious situation but the owners declined.
When the pug died, both her nostrils had red blood. Her tongue was cyanotic. So there was some respiratory damage and bleeding. "An independent post-mortem by the AVA will be needed to ascertain the cause of death," I said to the lady whom I phoned. "The dog is old and her immune system would be weak and she was not able to fight off the viruses and bacteria of kennel cough," I said. Cremation was arranged and the urn would be available in 2 days' time. It is one of the cases where old dogs without vaccination should not be exposed to other dogs. The pug was having her nails clipped and she panted at the pet shop. It was a sad Sunday for me as the pug had not shown any signs of impending death at the Surgery. In fact he had eaten some food after treatment with antibiotics and a drip. However, I had warned the owner of a possible death and the owners were understanding.
736. Health of Westie
The Westie Foundation of Amercia - health matters funded.
Atopic dermatitits (an allergice skin disease)
Bladder cancer
Idiopathic pulmonary fibrosis (lung scars)
Copper toxicity (hepatitis & liver failure)
Legg-Calve-Perthes disease (hip joint degenerative disease)
Luxating patellas (dislocating knee caps)
Addison's disease
Inflammatory bowel disease
Cataract
Dry eye (keratoconjunctivitis sicca)
Cranio-mandibular osteopathy (painful bone growths in the skull and jaw b ut usually OK by 12 months of age)
White shaker dog syndrome (entire body shakes or trembles - appear in other small white breeds - immune system disorder suspected - successfully treated with steroids).
Atopic dermatitits (an allergice skin disease)
Bladder cancer
Idiopathic pulmonary fibrosis (lung scars)
Copper toxicity (hepatitis & liver failure)
Legg-Calve-Perthes disease (hip joint degenerative disease)
Luxating patellas (dislocating knee caps)
Addison's disease
Inflammatory bowel disease
Cataract
Dry eye (keratoconjunctivitis sicca)
Cranio-mandibular osteopathy (painful bone growths in the skull and jaw b ut usually OK by 12 months of age)
White shaker dog syndrome (entire body shakes or trembles - appear in other small white breeds - immune system disorder suspected - successfully treated with steroids).
Friday, November 18, 2011
735. Inspirational picture
MESSAGE TO AN ENTREPRENEUR
As regards your water project, I am reminded of this martial arts movie "Dead Or Alive" which is free online and just watched by me as I do my early morning internet work. In the movie, the antagonist mentioned 3 words about the Japanese lady not up to the mark as her brother. She needs "Skills, Timing and Strength" but she has no "strength".
Somehow, these 3 words seem apt for your project in wanting to expand your business from Singapore to China and Indonesia. I was wondering what to write in a picture of flowers I just took last Saturday at Sentosa. Now, I know and I produce a picture to encourage you.
1. The timing is right (environmental health concern for clean water), the skill is there (your brother) but the strength (of the parties doing marketing) is to be established and you have got the expatriate
and others you are networking to build up a team to increase your strength.
2. Thinking of making money all the time will not make one be successful in business, in my opinion.
As regards your water project, I am reminded of this martial arts movie "Dead Or Alive" which is free online and just watched by me as I do my early morning internet work. In the movie, the antagonist mentioned 3 words about the Japanese lady not up to the mark as her brother. She needs "Skills, Timing and Strength" but she has no "strength".
Somehow, these 3 words seem apt for your project in wanting to expand your business from Singapore to China and Indonesia. I was wondering what to write in a picture of flowers I just took last Saturday at Sentosa. Now, I know and I produce a picture to encourage you.
1. The timing is right (environmental health concern for clean water), the skill is there (your brother) but the strength (of the parties doing marketing) is to be established and you have got the expatriate
and others you are networking to build up a team to increase your strength.
2. Thinking of making money all the time will not make one be successful in business, in my opinion.
Thursday, November 17, 2011
734. SOP - Lameness in a Golden Retriever
Thursday, Nov 17, 2011
9.30 am
I usually consult from 9.30 am to 11 am.
A lady owner and two friends consulted me for a 2nd opinion as regards her 9-month-old male Golden Retriever. born Feb 2011, limping on right hind for the last few weeks. Vet 1 had been consulted earlier regarding some skin disease.
Below are my Standard Operating Procedures for examination of canine lameness at Toa Payoh Vets for this case as a real case example as it is easier for reader to understand. Basically it is similar to examination of a lame horse.
1. HISTORY OF LAMENESS - Right Hind lamenss
Purchase - 3 months old from a Pasir Ris breeder
Onset - RH lame seen at 7th month
Duration - 2 months
Further questioning: The puppy does not jump up or down car and does not hop down stairs since purchase. Pain in hip and other joints likely to be present before purchase as most normal puppies will do the jumping.
2. LAMENESS EXAMINATION - Outside the Surgery. As in the racehorse lameness exam.
2.1 Walk
2.2 Trot
2.3 Turn
Limping on right hind obvious as the dog did not put weight on this leg and the left hind hip dipped on trotting.
3. PUT ON EXAMINATION TABLE - Do not examine on the floor!
3.1 Pain check of dog standing esp. spinal area. Spinal T5-L5 slightly painful.
3.2 Pain check by palpation of joints with dog lying down sideways on the table.
Slight pain on extension of right hip and right knee.
3.3 Dog recumbent on right side. Extend and flex all joints vigorously. The owners were worried about my vigorous manipulations but the dog did not react since he had no pain from the extensions and flexions. Some vets do gentle manipulations and mis-diagnose.
3.4 Dog standing on table. Compare length of right and left hind limb by extension and show to the owner the lengths of two hind limbs. In this case, the owner could see that the riight hind was noticeably shorter by 2-4 cm. Subluxation? Mild pain only. To X-ray both hip joints later.
3.5 There are other reflexes to be checked if the dog is paralysed but in this case, it is not. Refer to your neurological exam book.
4. TENTATIVE DIAGNOSIS
Right hip dysplasia likely as this condition is better shown at the 9th - 12th month than as a young pup. To X-ray hip joints at a later date.
5. ADVICES
5.1 No weight gain throughout his life, thereby avoiding surgery
5.2 No slopes or stair climbing or jumping from sofas etc
6. SKIN DISEASE. A separate case study and procedure which will not be written up here. Generalised pustular dermatitis, elbow and hock sores. Dog likes to sleep on wet floors. Anal sacculitis (pink hairless areas below anus pointed out by the owner). Rashes seen on elbows and hock area pigmentation suggested licking and early onset of elbow and hock sores. Preventive measures including moisturers for a time. The owner asked for Neoderm cream. No cream advised by me as the hair will not grow if the cream is used for a long time.
Best is daily grooming and inspection of the coat for this Golden Retriever and know where the "hot spots" will occur. Dog is clipped bald. Generally, the skin infections are due to bacteria but the vet cannot rule out ringworm and demodectic mites. Vet 1 had scraped skin and found no mites but there was no medical report given to the owner.
9.30 am
I usually consult from 9.30 am to 11 am.
A lady owner and two friends consulted me for a 2nd opinion as regards her 9-month-old male Golden Retriever. born Feb 2011, limping on right hind for the last few weeks. Vet 1 had been consulted earlier regarding some skin disease.
Below are my Standard Operating Procedures for examination of canine lameness at Toa Payoh Vets for this case as a real case example as it is easier for reader to understand. Basically it is similar to examination of a lame horse.
1. HISTORY OF LAMENESS - Right Hind lamenss
Purchase - 3 months old from a Pasir Ris breeder
Onset - RH lame seen at 7th month
Duration - 2 months
Further questioning: The puppy does not jump up or down car and does not hop down stairs since purchase. Pain in hip and other joints likely to be present before purchase as most normal puppies will do the jumping.
2. LAMENESS EXAMINATION - Outside the Surgery. As in the racehorse lameness exam.
2.1 Walk
2.2 Trot
2.3 Turn
Limping on right hind obvious as the dog did not put weight on this leg and the left hind hip dipped on trotting.
3. PUT ON EXAMINATION TABLE - Do not examine on the floor!
3.1 Pain check of dog standing esp. spinal area. Spinal T5-L5 slightly painful.
3.2 Pain check by palpation of joints with dog lying down sideways on the table.
Slight pain on extension of right hip and right knee.
3.3 Dog recumbent on right side. Extend and flex all joints vigorously. The owners were worried about my vigorous manipulations but the dog did not react since he had no pain from the extensions and flexions. Some vets do gentle manipulations and mis-diagnose.
3.4 Dog standing on table. Compare length of right and left hind limb by extension and show to the owner the lengths of two hind limbs. In this case, the owner could see that the riight hind was noticeably shorter by 2-4 cm. Subluxation? Mild pain only. To X-ray both hip joints later.
3.5 There are other reflexes to be checked if the dog is paralysed but in this case, it is not. Refer to your neurological exam book.
4. TENTATIVE DIAGNOSIS
Right hip dysplasia likely as this condition is better shown at the 9th - 12th month than as a young pup. To X-ray hip joints at a later date.
5. ADVICES
5.1 No weight gain throughout his life, thereby avoiding surgery
5.2 No slopes or stair climbing or jumping from sofas etc
6. SKIN DISEASE. A separate case study and procedure which will not be written up here. Generalised pustular dermatitis, elbow and hock sores. Dog likes to sleep on wet floors. Anal sacculitis (pink hairless areas below anus pointed out by the owner). Rashes seen on elbows and hock area pigmentation suggested licking and early onset of elbow and hock sores. Preventive measures including moisturers for a time. The owner asked for Neoderm cream. No cream advised by me as the hair will not grow if the cream is used for a long time.
Best is daily grooming and inspection of the coat for this Golden Retriever and know where the "hot spots" will occur. Dog is clipped bald. Generally, the skin infections are due to bacteria but the vet cannot rule out ringworm and demodectic mites. Vet 1 had scraped skin and found no mites but there was no medical report given to the owner.
Tuesday, November 15, 2011
733. Kennel cough follow-up by text message
The young generation prefers to text but it is not good when it comes to your pug's illness as illustrated in the following case.
Nov 13, 2011 10.59 am
Good morning Dr Sing.This is ... the owner of Zorro (Pug). We visited your cllinic on 8th. My puppy was having kennel cough and runny nose. He used to eat well and was active but this morning, he is not having any food and keeps on sleeping. When he walks, he has difficulty walking due to heavy coughing. So he walks a bit and then just sits down and he is not active anymore. Antibiotic has not been finished yet but since he seems not well, should I bring him back to the clinic?
It would be much appreciated if you could reply to my sms
Nov 13, 2011 12.04 pm
Pl tel me
NO REPLY. I PHONED. NO REPONSE.
Nov 13, 2011 9.31 pm
Dr Sing, I really need your help now with my pug. For all day, he rarely moved and seems no energy with him. Is there any chance we can bring him for emergency now?
I PHONED THE OWNER. As the pug was ok, I advised giving him a teaspoonful of honey + water and bring back to the clinic at 10 am on Nov 14.
On examination, the pug had copious amounts of nasal discharge. Difficulty in breathing. Some lung sounds, but no fever. I gave treatment and cough mixture.
"It is not possible to cage him 100% at home," I had advised the couple who brought the pug to me for examination one day after purchase on Nov 8.
"Play with the pug for only 5 minutes after meals which were given twice a day," I had advised. "Kennel cough is caused by virus and bacteria. Viral diseases do not have antibiotics but resting the puppy by confinement strictly in a cage will help speed recovery. Some cases take up to 3 weeks to recover."
In this case, the pug had space to run around as all puppies take advantage of freedom at a new house. He also hated taking medicine as he fought me when I syringe him 0.05 ml of the cough mixture.
"It is difficult to give him medicine by mouth," the young man said. "My pug rests his head on a soft toy," the gentleman said.
"Puppies do that when they can't breathe properly," I said. I rolled up a towel like a small pillow. The pug rested his neck on the edge of the pillow. Eyes bright but he was tired.
"Can we visit him for 15 minutes?" the gentleman asked.
"Yes," I said. "But this pug must be inside the cage for the next 2-3 days to rest." The couple came at 7 pm on the same day. Nursing, feeding, electrolytes and observation are made every 2 hourly to ensure that the pug is OK.
Nov 13, 2011 10.59 am
Good morning Dr Sing.This is ... the owner of Zorro (Pug). We visited your cllinic on 8th. My puppy was having kennel cough and runny nose. He used to eat well and was active but this morning, he is not having any food and keeps on sleeping. When he walks, he has difficulty walking due to heavy coughing. So he walks a bit and then just sits down and he is not active anymore. Antibiotic has not been finished yet but since he seems not well, should I bring him back to the clinic?
It would be much appreciated if you could reply to my sms
Nov 13, 2011 12.04 pm
Pl tel me
NO REPLY. I PHONED. NO REPONSE.
Nov 13, 2011 9.31 pm
Dr Sing, I really need your help now with my pug. For all day, he rarely moved and seems no energy with him. Is there any chance we can bring him for emergency now?
I PHONED THE OWNER. As the pug was ok, I advised giving him a teaspoonful of honey + water and bring back to the clinic at 10 am on Nov 14.
On examination, the pug had copious amounts of nasal discharge. Difficulty in breathing. Some lung sounds, but no fever. I gave treatment and cough mixture.
"It is not possible to cage him 100% at home," I had advised the couple who brought the pug to me for examination one day after purchase on Nov 8.
"Play with the pug for only 5 minutes after meals which were given twice a day," I had advised. "Kennel cough is caused by virus and bacteria. Viral diseases do not have antibiotics but resting the puppy by confinement strictly in a cage will help speed recovery. Some cases take up to 3 weeks to recover."
In this case, the pug had space to run around as all puppies take advantage of freedom at a new house. He also hated taking medicine as he fought me when I syringe him 0.05 ml of the cough mixture.
"It is difficult to give him medicine by mouth," the young man said. "My pug rests his head on a soft toy," the gentleman said.
"Puppies do that when they can't breathe properly," I said. I rolled up a towel like a small pillow. The pug rested his neck on the edge of the pillow. Eyes bright but he was tired.
"Can we visit him for 15 minutes?" the gentleman asked.
"Yes," I said. "But this pug must be inside the cage for the next 2-3 days to rest." The couple came at 7 pm on the same day. Nursing, feeding, electrolytes and observation are made every 2 hourly to ensure that the pug is OK.
Sunday, November 13, 2011
731. Animal Welfare Activists
On Mon, Sep 5, 2011 at 12:39 PM, ...@gmail.com> wrote:
Attention to the Veterinary Head of Toa Payoh Vets,
My name is ... and I am working full time for a church in Singapore.
Our church is currently in the process of getting a new animal shelter set up in Singapore. We are waiting for tenders from AVA or SLA for dog farms in Sungei Tengah. The shelter should be up and going in about 1 or 2 year's time. Our emphasis will specifically be to help stray or abandoned dogs. We are serious about this ministry and is looking forward toward setting it up as soon as possible.
The reason for writing to you is to ask if your clinic would be be interested to participate in the sterilization, vaccination and medical treatment program of our dogs.
We hope that you could partner with us in this good cause.
If so, please let us know how much you will charge us (roughly) for the following services so that we can better estimate our financial planning. We would greatly appreciate if you could give us a subsidized rate that is lower than the market.
Vaccination of a dog (regardless of size & inclusive of medication)
Sterilization of a dog (regardless of size & inclusive of medication)
Microchipping
Consultation fee
Medication discount
Essential Products such as heartguard, frontline
Medicated shampoos
Hope to hear from you soon. Thank you.
Alternatively, if any of your vets are interested to help on an individual, voluntary or private basis, please also respond to me.
God bless you,
...
On Mon, Sep 5, 2011 at 4:00 PM, Kelly Lim wrote:
Dear Dr Sing
Thank you for your prompt reply. We will contact you again when we have the latest update.
God bless you,
....
E-MAIL REPLY FROM DR SING DATED SEP 5, 2011
I am Dr Sing. As there is inflation and prices go up yearly, it is not possible to quote now and there will be misunderstandings when your shelter is built in 2-4 years' s time. Please let me know when the tender has been successful.
E-MAIL TO DR SING DATED NOV 11, 2011
On Fri, Nov 11, 2011 at 10:40 AM, ...gmail.com> wrote:
Dear Dr Sing
I am .., who have previously communicated with you over a few emails regarding our church's planned shelter for stray dogs. We have confirmed with AVA about the timing of the tender. It will probably be open only in 2013.
However, in the meanwhile, we can't just sit and wait for the land to come and ignore the terrible plight of the stray dogs. For the past 2 years, a few of us have already been feeding about 70 strays here and there, as well as actively putting up adoption for the puppies. We have our puppies screened for parvo virus, vaccinated & dewormed before giving them away for adoption. For the grown dogs, we have also got a few happily adopted. So far they are all success stories. We also sterilize the females. Many of them are sterilized except for about 10 more because they are very smart. Yet 10 females can reproduce beyond what we can cope. Still trying our best to patiently gain their trust.
Occasionally tragedies still happen. This year, we lost 2 batches of 8-9 puppies (could not catch them in time when they were about 5 weeks old and started running around in the open) that were in one night swept by the China and Thai workers for their "makan". These workers usually congregate over weekends and that is when they will notice the puppies and gang up to catch all of them.
Recently 1 black mongrel puppy was kicked to death at 3 month old and the other one blinded by the impact but a miracle happened and his eyesight is restored. Now he is in a foster home. They were the only ones left un-adopted because they were black in color.
So far I have visited ... and .... They do have 10% discount for strays but the bills still come up to an exorbitant amount for so many dogs.
Would you be able to propose a medical service package for us during these 2 years of transition before our shelter is formally up?
Looking forward to your reply.
God bless you,
...
E-MAIL REPLY DATED NOV 13, 2011
I am sorry I can't help you as my clinic is very small with 1 full-time vet, unlike ... and ... and other clinics who have many vets. In any case, I advise you to contact the newer clinics (there are over 40 clinics) in Singapore and these may be able to help you. You just need to do so personally. E-mails save time but not so good if you want to be an activist.
Attention to the Veterinary Head of Toa Payoh Vets,
My name is ... and I am working full time for a church in Singapore.
Our church is currently in the process of getting a new animal shelter set up in Singapore. We are waiting for tenders from AVA or SLA for dog farms in Sungei Tengah. The shelter should be up and going in about 1 or 2 year's time. Our emphasis will specifically be to help stray or abandoned dogs. We are serious about this ministry and is looking forward toward setting it up as soon as possible.
The reason for writing to you is to ask if your clinic would be be interested to participate in the sterilization, vaccination and medical treatment program of our dogs.
We hope that you could partner with us in this good cause.
If so, please let us know how much you will charge us (roughly) for the following services so that we can better estimate our financial planning. We would greatly appreciate if you could give us a subsidized rate that is lower than the market.
Vaccination of a dog (regardless of size & inclusive of medication)
Sterilization of a dog (regardless of size & inclusive of medication)
Microchipping
Consultation fee
Medication discount
Essential Products such as heartguard, frontline
Medicated shampoos
Hope to hear from you soon. Thank you.
Alternatively, if any of your vets are interested to help on an individual, voluntary or private basis, please also respond to me.
God bless you,
...
On Mon, Sep 5, 2011 at 4:00 PM, Kelly Lim
Dear Dr Sing
Thank you for your prompt reply. We will contact you again when we have the latest update.
God bless you,
....
E-MAIL REPLY FROM DR SING DATED SEP 5, 2011
I am Dr Sing. As there is inflation and prices go up yearly, it is not possible to quote now and there will be misunderstandings when your shelter is built in 2-4 years' s time. Please let me know when the tender has been successful.
E-MAIL TO DR SING DATED NOV 11, 2011
On Fri, Nov 11, 2011 at 10:40 AM, ...gmail.com> wrote:
Dear Dr Sing
I am .., who have previously communicated with you over a few emails regarding our church's planned shelter for stray dogs. We have confirmed with AVA about the timing of the tender. It will probably be open only in 2013.
However, in the meanwhile, we can't just sit and wait for the land to come and ignore the terrible plight of the stray dogs. For the past 2 years, a few of us have already been feeding about 70 strays here and there, as well as actively putting up adoption for the puppies. We have our puppies screened for parvo virus, vaccinated & dewormed before giving them away for adoption. For the grown dogs, we have also got a few happily adopted. So far they are all success stories. We also sterilize the females. Many of them are sterilized except for about 10 more because they are very smart. Yet 10 females can reproduce beyond what we can cope. Still trying our best to patiently gain their trust.
Occasionally tragedies still happen. This year, we lost 2 batches of 8-9 puppies (could not catch them in time when they were about 5 weeks old and started running around in the open) that were in one night swept by the China and Thai workers for their "makan". These workers usually congregate over weekends and that is when they will notice the puppies and gang up to catch all of them.
Recently 1 black mongrel puppy was kicked to death at 3 month old and the other one blinded by the impact but a miracle happened and his eyesight is restored. Now he is in a foster home. They were the only ones left un-adopted because they were black in color.
So far I have visited ... and .... They do have 10% discount for strays but the bills still come up to an exorbitant amount for so many dogs.
Would you be able to propose a medical service package for us during these 2 years of transition before our shelter is formally up?
Looking forward to your reply.
God bless you,
...
E-MAIL REPLY DATED NOV 13, 2011
I am sorry I can't help you as my clinic is very small with 1 full-time vet, unlike ... and ... and other clinics who have many vets. In any case, I advise you to contact the newer clinics (there are over 40 clinics) in Singapore and these may be able to help you. You just need to do so personally. E-mails save time but not so good if you want to be an activist.
Thursday, November 10, 2011
730. AVA Reponsible Pet Ownership Roadshow 2011 - Toa Payoh Vets
TOA PAYOH VETS
Block 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074
6254-3326, 9668-6469, judy@toapayohvets.com, www.toapayohvets.com
Speaker: Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Founder & Practising Veterinarian, Toa Payoh Vets
Saturday, November 12, 2011
Nov 10, 2011
AVA Responsible Pet Ownership Roadshow 2011
Saturday, November 12, 2011, 1.30 pm - 2 pm, Changi Expo
"SOME COMMON DISEASES IN DOGS"
I accepted two slots on Saturday and Sunday to present a talk on dogs and hamsters respectively. However, the AVA cancelled my Sunday talk scheduled from 3.30 pm to 4 pm and offered me another slot at 1.30 pm. I am unable to take up this slot.
Therefore, I will talk about common diseases in hamsters on this Saturday as dwarf hamsters are quite popular with Singaporeans.
In short, I will be presenting some health care cases mainly in dogs. However, the responsibilities of health care and ownership in canine cases apply to the care of cats, hamsters and rabbits.
I apologise for the inconvenience caused to the audience who expect only canine matters to be presented.
As Power Point slide presentations of "Responsible Pet Ownership" can be extremely dull and sleep-inducing in my experience, I have just got videos produced and hope all of you will enjoy the stories based on some common real life cases encountered at Toa Payoh Vets. The stories cover some common cases seen at Toa Payoh Vets from the birth to old age of the pets from around 1980 to 2011.
If you have any questions about responsible pet ownership as regards health care matters or the the cases in the videos, some details are available at www.toapayohvets.com.
If not, tel me at the Surgery at 6254-3326, 9668-6469 or e-mail judy@toapayohvets.com
Block 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074
6254-3326, 9668-6469, judy@toapayohvets.com, www.toapayohvets.com
Speaker: Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Founder & Practising Veterinarian, Toa Payoh Vets
Saturday, November 12, 2011
Nov 10, 2011
AVA Responsible Pet Ownership Roadshow 2011
Saturday, November 12, 2011, 1.30 pm - 2 pm, Changi Expo
"SOME COMMON DISEASES IN DOGS"
I accepted two slots on Saturday and Sunday to present a talk on dogs and hamsters respectively. However, the AVA cancelled my Sunday talk scheduled from 3.30 pm to 4 pm and offered me another slot at 1.30 pm. I am unable to take up this slot.
Therefore, I will talk about common diseases in hamsters on this Saturday as dwarf hamsters are quite popular with Singaporeans.
In short, I will be presenting some health care cases mainly in dogs. However, the responsibilities of health care and ownership in canine cases apply to the care of cats, hamsters and rabbits.
I apologise for the inconvenience caused to the audience who expect only canine matters to be presented.
As Power Point slide presentations of "Responsible Pet Ownership" can be extremely dull and sleep-inducing in my experience, I have just got videos produced and hope all of you will enjoy the stories based on some common real life cases encountered at Toa Payoh Vets. The stories cover some common cases seen at Toa Payoh Vets from the birth to old age of the pets from around 1980 to 2011.
If you have any questions about responsible pet ownership as regards health care matters or the the cases in the videos, some details are available at www.toapayohvets.com.
If not, tel me at the Surgery at 6254-3326, 9668-6469 or e-mail judy@toapayohvets.com
Wednesday, November 9, 2011
729. Right ear weeping in a Westie - an unusual case
"I have seen 3 vets. One of them said there might be a tumour inside the right ear," the young lady said to me. "The last vet advised ear surgery." From my impressions, the young couple wanted a permanent solution to this one-year problem of the Westie with the itchy right ear and they came to see me.
This dog had lots of "water" inside the ear canal. I palpated the right ear. There was some pain as the dog moved his head away. But not great pain. As I pressed the ear, more "watery" discharge come out. As I cleared the discharge with a piece of tissue and then pressed the ear, more "watery" discharge comes out. Not those thick yellow pus, but watery. Why?
It was as if the horizontal ear canal was a deep well with lots of water. "Did your father apply the commercial ear drops recently?" I asked.
"No," the young lady said. "No more ear drops left."
This was a most unusual case. It was as if there was "underground" water.
"This ear needed to be irrigated," I advised.
I collaborate with Dr Vanessa on this case as part of my mentorship and succession program for Toa Payoh Vets.
Each young vet has his or her own idea of treatment and I wanted to make sure that this dog had a treatment that I would be doing and to maintain a standard of care that would be satisfactory to dog owners who come to Toa Payoh Vets for second or more opinions.
TREATMENT
Domitor IV sedated the dog partly. Muzzled. Dr Vanessa put in the pink antiseptic solution into the ear canal, massaged it to clear the debri. That is the standard way and that would be what the other vets had been doing. Nothing wrong with that.
But it might not be effective compared to ear irrigation.
So I intervened and demonstrated how the ear irrigation ought to be done. There is a technique. I had shown this in my video at:
http://www.youtube.com/watch?v=xhZ5eGJdwnY
Dr Vanessa used the 20-ml syringe to flush the ear. "You need to exercise your thumb muscles," I said as she injected the water into the ear without much force. "The irrigation angle has to be at 45 degrees to the horizontal canal and with speed," I demonstrated. It is easier said and demonstrated than done.
White tissue pieces from the walls of the vertical canal came out. Large extensive ulcers. As I irrigated more, a small piece of brown tissue came out. Then a few more brown bits. Strange. No pus.
I left the room to talk to the couple. Then I returned to the room to continue working with Dr Vanessa. She had extracted a big amount of brownish fibres from deep inside the ear. Good work. "What are these brown stuff?" I asked her.
"It could be tumours," she said. We showed the brown fibres to the young couple who was equally as perplexed.
"Did your father use cotton buds to clean the right ear?" I asked.
"Yes," the lady said. Later she said that her father used cotton wool wrapped around a pair of forceps to clean this ear.
So, the clue was given. The father would have used lots of cotton wool over the past year to resolve the ear problem. The fibres loosened and got impacted inside the horizontal canal. The whole canal filled up. The fibres absorbed the "water" of the commercial ear drops. At the same time, the bleeding from the canal wall due to aggressive ear cleaning by the father stained the fibres into dark brown as red blood becomes brown over time. These were the fibres or "tumours" pulled out.
Is this hypothesis sound? It is an unusual case as there was no pus. No time for pus to form too as the father must be doing ear cleaning every day. Sometimes, the grown up children don't know what the father is doing in the care of the dog as they work long hours.
Dr Vanessa extracted as much as possible. Evidence shown. She showed the couple the ear canal via the auroscope.
Ear swab for bacterial culture. Blood test.
SOLUTION
My advice was to lateral canal resection to resolve the dog's problem once and for all. The impacted cotton wool is deep inside the horizontal canal and opening up the vertical canal to get the hidden wool is the best solution. Owners want one treatment not several visits. This is understandable for every one. I advise surgery one week later.
This dog had lots of "water" inside the ear canal. I palpated the right ear. There was some pain as the dog moved his head away. But not great pain. As I pressed the ear, more "watery" discharge come out. As I cleared the discharge with a piece of tissue and then pressed the ear, more "watery" discharge comes out. Not those thick yellow pus, but watery. Why?
It was as if the horizontal ear canal was a deep well with lots of water. "Did your father apply the commercial ear drops recently?" I asked.
"No," the young lady said. "No more ear drops left."
This was a most unusual case. It was as if there was "underground" water.
"This ear needed to be irrigated," I advised.
I collaborate with Dr Vanessa on this case as part of my mentorship and succession program for Toa Payoh Vets.
Each young vet has his or her own idea of treatment and I wanted to make sure that this dog had a treatment that I would be doing and to maintain a standard of care that would be satisfactory to dog owners who come to Toa Payoh Vets for second or more opinions.
TREATMENT
Domitor IV sedated the dog partly. Muzzled. Dr Vanessa put in the pink antiseptic solution into the ear canal, massaged it to clear the debri. That is the standard way and that would be what the other vets had been doing. Nothing wrong with that.
But it might not be effective compared to ear irrigation.
So I intervened and demonstrated how the ear irrigation ought to be done. There is a technique. I had shown this in my video at:
http://www.youtube.com/watch?v=xhZ5eGJdwnY
Dr Vanessa used the 20-ml syringe to flush the ear. "You need to exercise your thumb muscles," I said as she injected the water into the ear without much force. "The irrigation angle has to be at 45 degrees to the horizontal canal and with speed," I demonstrated. It is easier said and demonstrated than done.
White tissue pieces from the walls of the vertical canal came out. Large extensive ulcers. As I irrigated more, a small piece of brown tissue came out. Then a few more brown bits. Strange. No pus.
I left the room to talk to the couple. Then I returned to the room to continue working with Dr Vanessa. She had extracted a big amount of brownish fibres from deep inside the ear. Good work. "What are these brown stuff?" I asked her.
"It could be tumours," she said. We showed the brown fibres to the young couple who was equally as perplexed.
"Did your father use cotton buds to clean the right ear?" I asked.
"Yes," the lady said. Later she said that her father used cotton wool wrapped around a pair of forceps to clean this ear.
So, the clue was given. The father would have used lots of cotton wool over the past year to resolve the ear problem. The fibres loosened and got impacted inside the horizontal canal. The whole canal filled up. The fibres absorbed the "water" of the commercial ear drops. At the same time, the bleeding from the canal wall due to aggressive ear cleaning by the father stained the fibres into dark brown as red blood becomes brown over time. These were the fibres or "tumours" pulled out.
Is this hypothesis sound? It is an unusual case as there was no pus. No time for pus to form too as the father must be doing ear cleaning every day. Sometimes, the grown up children don't know what the father is doing in the care of the dog as they work long hours.
Dr Vanessa extracted as much as possible. Evidence shown. She showed the couple the ear canal via the auroscope.
Ear swab for bacterial culture. Blood test.
SOLUTION
My advice was to lateral canal resection to resolve the dog's problem once and for all. The impacted cotton wool is deep inside the horizontal canal and opening up the vertical canal to get the hidden wool is the best solution. Owners want one treatment not several visits. This is understandable for every one. I advise surgery one week later.
728. Scupturing dogs with veggie dyes and making them look like pandas etc - animal cruelty?
MY REPLY TO COMMENTS ON DOG DYED TO LOOK LIKE PANDAS AND OTHER ANIMALS
Thank you for your email. I have not seen one client Toa Payoh Vets with coloured/dyed dogs from 1982 to 2011. It is surprising.
If I do, I will advise the owner to check whether the dye is carcinogenic, allergic or toxic to the dog when licked and in the long term.
Nowadays, what is deemed animal cruelty in subjecting a dog to being dyed to one person is not cruel to another. As long as the quality of life of the pet is good and the pet is healthy despite "vegetable-dyed", I am not against this practice which you may consider cruel.
Older men and women dye their white or grey hairs to look younger. Young people dye their hair to look different. Such hair dyes may have long term toxic effects on the kidneys and livers as they are used for a long time to maintain youthfulness esp. in older people. This is my opinion that is not supported by scientific evidence, if any.
But most people don't bother about the safety aspects and that is why so many "herbal" and "nutritional/vitamin" pills with possible harmful effects to the liver and kidneys have great sales.
I hope my reply is satisfactory to you.
Thank you for your email. I have not seen one client Toa Payoh Vets with coloured/dyed dogs from 1982 to 2011. It is surprising.
If I do, I will advise the owner to check whether the dye is carcinogenic, allergic or toxic to the dog when licked and in the long term.
Nowadays, what is deemed animal cruelty in subjecting a dog to being dyed to one person is not cruel to another. As long as the quality of life of the pet is good and the pet is healthy despite "vegetable-dyed", I am not against this practice which you may consider cruel.
Older men and women dye their white or grey hairs to look younger. Young people dye their hair to look different. Such hair dyes may have long term toxic effects on the kidneys and livers as they are used for a long time to maintain youthfulness esp. in older people. This is my opinion that is not supported by scientific evidence, if any.
But most people don't bother about the safety aspects and that is why so many "herbal" and "nutritional/vitamin" pills with possible harmful effects to the liver and kidneys have great sales.
I hope my reply is satisfactory to you.
727. Dr Sing's presentation at the AVA Responsible Pet Ownership Seminar Sat Nov 12, 2011 1.30pm to 2 pm
30 minute talk. Instead of boring power point slides on how to be a responsible pet owner in Singapore, I will be showing videos
My videos on caring for your pet to permit it to live longer and have a good quality of life will likely be:
1. Oro-fistula and follow up in an old Chihuahua who had had pyometra
2. How to bathe a Roborovski hamster with generalised skin disease
3. Ear irrigations for a Golden Retriever with chronic ear infections
4. Emergency Caesarean section advices for the home-breeder
5. FIV in a stray cat
6. Blood in the urine in a dog
7. Tumours, Perineal hernias, Circum-anal tumours in older pets including hamsters, dogs, cats
8. Eye ulcers are emergencies.
9. Puppy parvoviral disease and prevention by vaccination.
Early detection of diseases and removal of tumour save lives. Be a responsible pet owner.
I hope the videos will last the 30-minute of talk and be entertaining and useful for the audience
My videos on caring for your pet to permit it to live longer and have a good quality of life will likely be:
1. Oro-fistula and follow up in an old Chihuahua who had had pyometra
2. How to bathe a Roborovski hamster with generalised skin disease
3. Ear irrigations for a Golden Retriever with chronic ear infections
4. Emergency Caesarean section advices for the home-breeder
5. FIV in a stray cat
6. Blood in the urine in a dog
7. Tumours, Perineal hernias, Circum-anal tumours in older pets including hamsters, dogs, cats
8. Eye ulcers are emergencies.
9. Puppy parvoviral disease and prevention by vaccination.
Early detection of diseases and removal of tumour save lives. Be a responsible pet owner.
I hope the videos will last the 30-minute of talk and be entertaining and useful for the audience
726. Regional nerve block in vet dentistry video
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
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
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.
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