Yesterday, Tuesday Feb, I did an unuusual Chihuahua spay cum teaching session to Dr Daniel in the afternoon. In the evening, the mother phoned Dr Daniel and said the Chihuahua had died. I was shocked and very sad. However, the Chihuahua had given birth to 2 dead 52-day-old pups.
Today at 10 am, she phoned me to ask whether she should continue feeding egg yolk to the same Chihuahua. "Hold on," I said as I went to ask Dr Daniel as to what was happening. "She said the dog had died."
I asked the mother. "Oh, the dog was dying. She fainted but I could see her breathing. After 2 hours in this position, the dog woke up and is now OK."
This was incredible as I could not understand why the dog had died. Her death was on my mind this morning. She did have a cyantoic tongue on picture taking. She was taken home 2 hours after my surgery and Dr Daniel had checked she was OK.
BACKGROUND
Tuesday Feb 14, 2012
Home breeder Mr Lim phoned me to ask about Caesarean cost. I had charged $250-$300/Caesarean for breeders some 7 years ago and that was how he knew me as I was in the breeder Caesarean section business doing over 100 dystocias.
"The fees were too low," I had stopped servicing the breeders some 4 years ago. "It should be around $800 - $1,000."
VET 1 TREATMENT. Mr Lim was in Malaysia and so he sent his mum to Vet 1, a vet to get an IV drip first as his mum said the dam was dying since giving birth to two dead pups discovered on Monday morning. Now, it was Tuesday 1 pm and many hours had passed.
Vet 1 also did a blood test and ultrasounds. Possibly two dead fetus according to the ultrasound. I palpated the abdomen. There was a small firm lump of 8 cm x 8 cm which would be just the uterine body as a pup would be 2x larger. In any case, the mum said there were dead pups and so Caesarean was needed. But Mr Lim had instructed that I did it, and so the mum and daughter carried the Chihuahua and the IV drip bottle of 5% glucose saline, ultrasound and blood test from Vet 1 to my Surgery.
Home breeders want the least cost Caesarean sections and he just wanted Vet 1 to give the dog an IV drip first before sending to me. But he had the ultrasound and blood test. It was more costly now.
I spoke to Mr Lim by phone and advised spaying as the dog is 6 years old and had difficulty giving birth now. Mr Lim agreed and so I used this case as a demonstration of how I did a spay on a pregnant chihuahua to Dr Daniel. There was milk in the glands and so it was a surprise that Mr Lim said the pups born premature were 50-52 days. But he is a professional experienced home breeder and so I would accept his calculation.
The dog was severely dehydrated.
Wednesday, February 15, 2012
Monday, February 13, 2012
875. Sunday's interesting cases
Sunday, Feb 12, 2012
Bright sunny day. Two vets, excluding me are needed on Sunday to reduce waiting time to less than 15 minutes per client. Some cases like dental scaling takes around 30 minutes and if there is one vet, the clients who come later can complain of waiting over 2 hours. I had an early meeting with Dr Daniel, Mr Min and Mr Lim (intern) in the consultation room to discuss about work attitudes, behaviour, stock inventory, anaesthetic records, case records, surgical processes, efficiency and productivity, wastage of resources and time and consistency to enable my vision of Toa Payoh Vets to be the top 5 practices in Singapore. I asked Mr Lim to take minutes of this first meeting. Clients are younger and much more sophisticated as you can see from the cases described below.
Case 1
Golden Retriever's toe fracture as the wife had stepped on him. Review. Much less swollen. Still lame. I showed Dr Daniel how I would handle this case as I would have done in a racehorse. Outside the clinic, trotting and walking. He was limping but we knew which leg. Got X-rays. Cost the owners a bit of money.
"How's your daughter's guinea pig?" I enquired as I had clipped its overgrown cheek teeth and it was not eating for the next day. Vet 1 had treated it earlier with some injections but the GP was still not eating and had lost weight. I had the GP under anaesthesia to check the mouth and the cheek teeth were overgrown. So, this was the problem as the GP had become very thin by then.
"The GP is OK now. Eating," the wife said. "My daughter is a medical undergraduate. She ordered the emergency mixture via the internet and it cost a lot of money."
"I did advise her to go to a pet shop that specialises in GP and rabbits and will have it. In any case, how do you know it is expensive?"
Mum said: "I paid $50.00 for the goods delivered on the same day."
The internet is now what young adults do. I don't stock the mixture as there are not many cases of GP or rabbits. I had advised her to hand-fed the mashed up pellets and also the medication 6X/day in small amounts and also electrolytes. But she wanted prompt results of return to feeding and ordered the emergency mixture. It ended well for the GP. This case illustrates the importance of checking the cheek teeth and not just the front teeth. A similar case in a rabbit recently had been written in www.toapayohets.com
Case 2.
I did not expect any early birds as this was Sunday. Suddenly 2 young ladies came in at 10 am with an Italian Greyhound, 4 years, excellent bodily condition, and wanted dental scaling done. "Has the dog eaten?" I asked. "It may vomit out the food during anaesthesia or sedation."
"At 9am," one lady said. "Just a small amount. When I phoned for appointment yesterday, nobody told me not to feed the dog before surgery."
"I will do it at 4 pm, sufficient time to let the food pass through," I said.
"We live in Tampines," the lady said. This would take some time to go back and forth, at least 30 minutes.
To be practical, I got the dog done with Dr Daniel Sing, mentoring him by showing how I would do it. No problem using 50% of calculated dom and ket combination ination and isoflurane gas. Dog did not vomit. Went home to a happy lady after one hour.
Case 3
An elderly man came in specifically to see me to get his 8-year-old Jack Russell dental work. No dental done before. Dog was given same as the Italian Greyhound. But older. This is a higher risk. As before, I mentored Dr Daniel Sing. He had his own ideas from his professors and this is to be expected of young graduates. Full of theories and latest knowledge of vet medicine and that is good as you can see from one case of the sheltie with nasal discharge and the excellent X-rays taken.
However, the dog stopped breathing, according to Min. I was out a while but came back within 10 seconds, according to Dr Daniel in review of this case later. No time to test his theories. I know what the professors would have taught about injecting the emergency adrenalin etc. Time is of the essence.
I did cardiac massage, blew air into the lungs by cutting the tightly tied endotracheal tube to both jaws (I don't tie this way but the professors would have taught this is the correct way, in normal situations, correctly). "Give Antisedan inj IV" I said. Dog revived and was OK. Alert as a guard dog standing up. "Propofol to continue anaesthesia," Dr Daniel said as there was two teeth left to be scaled and the dog could bite.
"No more IV in this case as the dog's heart may stop," I said. "Just isoflurane gas by mask and it will take a longer time." The dog was treated.
P.S Propofol seems to be a favourite of recent Murdoch Univ trained vet graduates and is used much in the University. But I don't use propofol and there is no need for it as there are other alternatives available. New graduates must adapt to the workplace rather than replicating or using what they have seen being used by their professors.
A practice has to manage cost so as to provide the cheapest competitive veterinary services. It cannot stock similar drugs as they do expire and led to a high wastage of resources and money.
Bright sunny day. Two vets, excluding me are needed on Sunday to reduce waiting time to less than 15 minutes per client. Some cases like dental scaling takes around 30 minutes and if there is one vet, the clients who come later can complain of waiting over 2 hours. I had an early meeting with Dr Daniel, Mr Min and Mr Lim (intern) in the consultation room to discuss about work attitudes, behaviour, stock inventory, anaesthetic records, case records, surgical processes, efficiency and productivity, wastage of resources and time and consistency to enable my vision of Toa Payoh Vets to be the top 5 practices in Singapore. I asked Mr Lim to take minutes of this first meeting. Clients are younger and much more sophisticated as you can see from the cases described below.
Case 1
Golden Retriever's toe fracture as the wife had stepped on him. Review. Much less swollen. Still lame. I showed Dr Daniel how I would handle this case as I would have done in a racehorse. Outside the clinic, trotting and walking. He was limping but we knew which leg. Got X-rays. Cost the owners a bit of money.
"How's your daughter's guinea pig?" I enquired as I had clipped its overgrown cheek teeth and it was not eating for the next day. Vet 1 had treated it earlier with some injections but the GP was still not eating and had lost weight. I had the GP under anaesthesia to check the mouth and the cheek teeth were overgrown. So, this was the problem as the GP had become very thin by then.
"The GP is OK now. Eating," the wife said. "My daughter is a medical undergraduate. She ordered the emergency mixture via the internet and it cost a lot of money."
"I did advise her to go to a pet shop that specialises in GP and rabbits and will have it. In any case, how do you know it is expensive?"
Mum said: "I paid $50.00 for the goods delivered on the same day."
The internet is now what young adults do. I don't stock the mixture as there are not many cases of GP or rabbits. I had advised her to hand-fed the mashed up pellets and also the medication 6X/day in small amounts and also electrolytes. But she wanted prompt results of return to feeding and ordered the emergency mixture. It ended well for the GP. This case illustrates the importance of checking the cheek teeth and not just the front teeth. A similar case in a rabbit recently had been written in www.toapayohets.com
Case 2.
I did not expect any early birds as this was Sunday. Suddenly 2 young ladies came in at 10 am with an Italian Greyhound, 4 years, excellent bodily condition, and wanted dental scaling done. "Has the dog eaten?" I asked. "It may vomit out the food during anaesthesia or sedation."
"At 9am," one lady said. "Just a small amount. When I phoned for appointment yesterday, nobody told me not to feed the dog before surgery."
"I will do it at 4 pm, sufficient time to let the food pass through," I said.
"We live in Tampines," the lady said. This would take some time to go back and forth, at least 30 minutes.
To be practical, I got the dog done with Dr Daniel Sing, mentoring him by showing how I would do it. No problem using 50% of calculated dom and ket combination ination and isoflurane gas. Dog did not vomit. Went home to a happy lady after one hour.
Case 3
An elderly man came in specifically to see me to get his 8-year-old Jack Russell dental work. No dental done before. Dog was given same as the Italian Greyhound. But older. This is a higher risk. As before, I mentored Dr Daniel Sing. He had his own ideas from his professors and this is to be expected of young graduates. Full of theories and latest knowledge of vet medicine and that is good as you can see from one case of the sheltie with nasal discharge and the excellent X-rays taken.
However, the dog stopped breathing, according to Min. I was out a while but came back within 10 seconds, according to Dr Daniel in review of this case later. No time to test his theories. I know what the professors would have taught about injecting the emergency adrenalin etc. Time is of the essence.
I did cardiac massage, blew air into the lungs by cutting the tightly tied endotracheal tube to both jaws (I don't tie this way but the professors would have taught this is the correct way, in normal situations, correctly). "Give Antisedan inj IV" I said. Dog revived and was OK. Alert as a guard dog standing up. "Propofol to continue anaesthesia," Dr Daniel said as there was two teeth left to be scaled and the dog could bite.
"No more IV in this case as the dog's heart may stop," I said. "Just isoflurane gas by mask and it will take a longer time." The dog was treated.
P.S Propofol seems to be a favourite of recent Murdoch Univ trained vet graduates and is used much in the University. But I don't use propofol and there is no need for it as there are other alternatives available. New graduates must adapt to the workplace rather than replicating or using what they have seen being used by their professors.
A practice has to manage cost so as to provide the cheapest competitive veterinary services. It cannot stock similar drugs as they do expire and led to a high wastage of resources and money.
Saturday, February 11, 2012
Follow up by vet - the persistent coughing shih tzu
Yesterday, Friday, Feb 10, 2012, the owner brought the Shih Tzu for review as I had phoned him to enquire about the dog's coughing of white mucus.
"Eats a lot, poop a lot. Pee a lot," the owner said to me. "Is his coughing infectious to other dogs or the children?"
"No," I said. "The blood test is normal and the dog is more active and has no fever."
No weight gain for the past 7 days. "The tongue ulcer on the tip is still there," the owner said as the dog prevented me from checking the tonsils for several trials of opening his mouth. "The dog eats dry food as he likes it," I said. "This may have caused the big tongue ulcer, 1.0 x 0.8 cm from healing, Give canned food for the next 4 weeks, if possible."
The submandibular and popliteal lymph nodes were reduced in size by around 20%. I asked the owner to feel the nodes. The axillary lymph nodes were not palpable. He would be checking the size of the nodes.
Urine test had indicated high serum urea and bacteria in the urine.
I palpated the throat. The dog retched and coughed white mucus onto the table and then the floor. The man took my tissue paper to wipe away the white mucus.
"My dog vomits when he drinks a bit of water, two teaspoonfuls per meal," the owner said and had complied with my advice to feed small amounts 5x/day. "Now, he throws up around 5X/day, but previously it was 10 times or more."
After my treatment last week, the dog threw up once per day. So, the problem has not been resolved.
A follow up is important. So, what's the problem? Pleural effusion of the lungs and enlarged heart. How about stomach gas. "We need to X-ray the stomach/gullet area if this problem persists," I said.
"Eats a lot, poop a lot. Pee a lot," the owner said to me. "Is his coughing infectious to other dogs or the children?"
"No," I said. "The blood test is normal and the dog is more active and has no fever."
No weight gain for the past 7 days. "The tongue ulcer on the tip is still there," the owner said as the dog prevented me from checking the tonsils for several trials of opening his mouth. "The dog eats dry food as he likes it," I said. "This may have caused the big tongue ulcer, 1.0 x 0.8 cm from healing, Give canned food for the next 4 weeks, if possible."
The submandibular and popliteal lymph nodes were reduced in size by around 20%. I asked the owner to feel the nodes. The axillary lymph nodes were not palpable. He would be checking the size of the nodes.
Urine test had indicated high serum urea and bacteria in the urine.
I palpated the throat. The dog retched and coughed white mucus onto the table and then the floor. The man took my tissue paper to wipe away the white mucus.
"My dog vomits when he drinks a bit of water, two teaspoonfuls per meal," the owner said and had complied with my advice to feed small amounts 5x/day. "Now, he throws up around 5X/day, but previously it was 10 times or more."
After my treatment last week, the dog threw up once per day. So, the problem has not been resolved.
A follow up is important. So, what's the problem? Pleural effusion of the lungs and enlarged heart. How about stomach gas. "We need to X-ray the stomach/gullet area if this problem persists," I said.
872. TOILET TRAINING - The 3rd dog shows he is the boss - urine marking
EMAIL TO DR SING DATED FEB 10, 2012
...singnet.com.sg
Dear Dr,
I really need your advice how I can train my schnauzer. I have a total of 3 dogs, this schnauzer give me the most problem and seem to be not learning. He was the last to come in to my house. At the moment he is already 3 years old and I really not sure can I still toilet train him. As I have try many way to ask him to go and pee but always love to give surprise.
Both my other 2 dog are well toilet train and do it at the right place. The schnauzer really give me a problem. When I ask all the dogs to pees they will go to the toilet and pee. Normally my other 2 dogs will go in to pee first. The schnauzer will only go to pee after both dog have pee and try to pee over my other 2 dog pee. This is not a problem with him.
He always love to any how pee near to the door and other part in the kitchen for no reason. He will just pee a little bit here and there. I am not sure is he trying to get my attentions. Even he know it is wrong to do it he still do it. He seem to love to just pee a little to cover the 2 dog pees and have his own pee outside the toilet. I try to catch him in the act but was not successful. Normally after feeding I will try to get him to the toilet. But he will not do it even I spent 30 mins trying to get him to do it in the toilet. The moment. I leave him go to my room 5-10 minutes time when I am out he will pee near to the door or at the wrong sport. Any solutions which I can house break his bad habits.
Please help me and give suggestion. I am totally lost.
Regards,
EMAIL REPLY FROM DR SING DATED FEB 11, 2012
Kong Yuen Sing
5:51 PM (16 hours ago)
to Edwin, bcc: me, bcc: daniel, bcc: jasonxll
I am Dr Sing from www.toapayohvets.com. Thank you for your email.
It will be difficult to house-train the Schnauzer as he is 3 years old, not a puppy. He is urine-marking (pee over the other 2 dog's pee and elsewhere) to make sure that the other 2 dogs know he is the boss.
Some suggestions:
1. Neuter him soon.
2. After neuter, start house-training by confinement to one area or room for 2-6 weeks, if you have any space. Or use crate-training and take him out every 3-4 hour to pee. Basically same training as for puppies as described in toapayohvets.com, puppy house toilet training webpages.
3. Firm commands in house-training with rewards on success.
With best wishes.
...singnet.com.sg
Dear Dr,
I really need your advice how I can train my schnauzer. I have a total of 3 dogs, this schnauzer give me the most problem and seem to be not learning. He was the last to come in to my house. At the moment he is already 3 years old and I really not sure can I still toilet train him. As I have try many way to ask him to go and pee but always love to give surprise.
Both my other 2 dog are well toilet train and do it at the right place. The schnauzer really give me a problem. When I ask all the dogs to pees they will go to the toilet and pee. Normally my other 2 dogs will go in to pee first. The schnauzer will only go to pee after both dog have pee and try to pee over my other 2 dog pee. This is not a problem with him.
He always love to any how pee near to the door and other part in the kitchen for no reason. He will just pee a little bit here and there. I am not sure is he trying to get my attentions. Even he know it is wrong to do it he still do it. He seem to love to just pee a little to cover the 2 dog pees and have his own pee outside the toilet. I try to catch him in the act but was not successful. Normally after feeding I will try to get him to the toilet. But he will not do it even I spent 30 mins trying to get him to do it in the toilet. The moment. I leave him go to my room 5-10 minutes time when I am out he will pee near to the door or at the wrong sport. Any solutions which I can house break his bad habits.
Please help me and give suggestion. I am totally lost.
Regards,
EMAIL REPLY FROM DR SING DATED FEB 11, 2012
Kong Yuen Sing
5:51 PM (16 hours ago)
to Edwin, bcc: me, bcc: daniel, bcc: jasonxll
I am Dr Sing from www.toapayohvets.com. Thank you for your email.
It will be difficult to house-train the Schnauzer as he is 3 years old, not a puppy. He is urine-marking (pee over the other 2 dog's pee and elsewhere) to make sure that the other 2 dogs know he is the boss.
Some suggestions:
1. Neuter him soon.
2. After neuter, start house-training by confinement to one area or room for 2-6 weeks, if you have any space. Or use crate-training and take him out every 3-4 hour to pee. Basically same training as for puppies as described in toapayohvets.com, puppy house toilet training webpages.
3. Firm commands in house-training with rewards on success.
With best wishes.
Friday, February 10, 2012
871. An e-mail to Dr Sing about a cat
Feb 10, 2012. Veterinary medicine is a diverse topic. Feedbacks are valuable but most are complaints. This is one feedback that was surprising to me.
EMAIL TO DR SING DATED FEB 9, 2012
Dear Dr Sing
A belated Happy Lunar New Year to you. I trust this email finds you in good health and standing. Its been quite some time since our male cat Tobi was treated at your wonderful practice. Unfortunately our beloved Tobi has passed away on Saturday, 4 February 2012.
Just a bit of history. Tobi was admitted to your care on 24 April 2011. His case is listed in your website under cat cases-UTI -1st FLUTD.The cat can't pee again dated 12 June 2011. Shortly after his discharge, we moved into our new home. Tobi recovered well as there were no territorial cats and stress was kept to a minimum. He was maintained strictly on Hill's C/D wet food.
However, sometime from October 2011, he seemed to be licking his private area again though not as frequently as when he had UTI , he was also peeing normally with good volume. His disposition and general health was very good. This continued until February 2012 when we noticed his urine volume seemed to have lessened somewhat and his penis appeared to be inflamed. We brought him to a vet(shall not mention the company name) who gave him an injection of antibiotics and anti-inflammation and discharged. Two days later, it did not seem to get better, we brought him back to the vet again, a blood test was performed with several struvite crystals detected. The vet advised us that a similar injection could be given or a catheter could be inserted. We chose the injections as we were trying to avoid Tobi being warded as it may be more stressful. In order to give the injections, Tobi had to be put under G.A. as he was putting up such a struggle. Anyway it was done and he went home.
Yet again two days he was still having difficulty peeing, this time we opted to bring him to another branch (this branch was 24 hrs with larger facilities). Tobi was sedated, warded with a catheter inserted and put on a drip via a Y-site. He was also given daily IV feeds with Cephalexin and calcium, diazepam amongst others. He seemed fairly alright the first two days, it was only on the 3rd day that we noticed he appeared rather "subdued", quiet, not he's normal fiesty self. By the 4th day ,he was lying down the whole time and didnt seemed to respond to us. We attributed this to possible lethargy and medication. The next day, his blood tests were normal and after a cursory examination he was declared fit for discharge despite the fact that by now he could not even stand up or move, we bascially had to carry him into his carrier to be brought home. We reached home in the mid afternoon and put him in the room, again we had to carry him out of the carrier. From the time we reached home right until 10 pm, Tobi condition just deteriorated, once in while he would sort of jerk himself to another area in the room, Im not sure how he did this as he was immobile from the front quarters, his eyes could not track movement, he was drooling brown liquid and had raspy breathing. We took him back to the 24 hr branch at around 10.30 and the vet on duty arrived about 15 mins later,another blood test was conducted plus a chest x-ray, all looked normal, tests for leukemia and FIV was also done, clear as well. At about 11.30am, Tobi convulsed, expelled fluid and stopped breathing, we had opted for DNR. An immediate autospy was done, organs again were all fine. Nobody seems to have an answer for his death.
Needless to say, we are extremely saddened as well as puzzled by his sudden demise, more so when he was brought in for what ought to be a routine treatment for am inflamed penis. Instead five days later, we are having to cremate him. We have since search everywhere for anything information that might explain his sudden death. From what we found, we suspect, of course this may speculative at best, but it appears to be anaphylactic shock ( the question is what was the cause). Again we suspect it could he may have been allergic to one or more of the medications prescibed via the IV drip. Admittedly there could be numerous other possible causes. However we feel it seems to fit the symptoms Tobi displayed - pale gums, immobility, drooling, low temperature, increased heart rate.
We are not ones to assign blame or find fault. Nonetheless, suffice to say we are disappointed with the level of monitoring at the vetirinarian branch Tobi was in. We are well aware that cats are notorious for masking pain and discomfort but honestly to discharge a cat that can't even stand on its feet! It would be like a doctor discharging a patient who can't walk and asking him to go home. While Tobi's blood tests looked fine, a more thorougly physical examination would have raised one or more red flags. From the time of his passing, not one person from the vet had called to offer their condolences or at least offer some theory as to Tobi's death. It's as if that there was no obvious cause, so nobody can be bothered about it.
My wife and I are still coping with his passing but we are doing well. I just thought that since you treated Tobi twice and did such a wonderful job each time, we would like to let you know what has happened since then.
Thank you for taking time to read this long email. Meanwhile, we wish you all the best in your practice and your great care towards all animals, big and small.
P.S. we would have like to gone back to you but the distance was a bit prohibitive. Anyway we thought it would be just a routine treatment but......
Best Wishes & Regards
Name of young couple
EMAIL REPLY FROM DR SING DATED FEB 10, 2012
Hi
I thank you for your compliments and good wishes.
1. You mentioned "a blood test was performed with several struvite crystals detected"? Is it a urine test?
2. What is DNR?
3. Was an X-ray done?
4. Was a urine test done?
Please accept my condolences for the passing away of Tobi. Pl phone me if you have any queries about Tobi as it is easier to discuss on phone than by writing emails.
With best wishes for both of you.
EMAIL TO DR SING DATED FEB 9, 2012
Dear Dr Sing
A belated Happy Lunar New Year to you. I trust this email finds you in good health and standing. Its been quite some time since our male cat Tobi was treated at your wonderful practice. Unfortunately our beloved Tobi has passed away on Saturday, 4 February 2012.
Just a bit of history. Tobi was admitted to your care on 24 April 2011. His case is listed in your website under cat cases-UTI -1st FLUTD.The cat can't pee again dated 12 June 2011. Shortly after his discharge, we moved into our new home. Tobi recovered well as there were no territorial cats and stress was kept to a minimum. He was maintained strictly on Hill's C/D wet food.
However, sometime from October 2011, he seemed to be licking his private area again though not as frequently as when he had UTI , he was also peeing normally with good volume. His disposition and general health was very good. This continued until February 2012 when we noticed his urine volume seemed to have lessened somewhat and his penis appeared to be inflamed. We brought him to a vet(shall not mention the company name) who gave him an injection of antibiotics and anti-inflammation and discharged. Two days later, it did not seem to get better, we brought him back to the vet again, a blood test was performed with several struvite crystals detected. The vet advised us that a similar injection could be given or a catheter could be inserted. We chose the injections as we were trying to avoid Tobi being warded as it may be more stressful. In order to give the injections, Tobi had to be put under G.A. as he was putting up such a struggle. Anyway it was done and he went home.
Yet again two days he was still having difficulty peeing, this time we opted to bring him to another branch (this branch was 24 hrs with larger facilities). Tobi was sedated, warded with a catheter inserted and put on a drip via a Y-site. He was also given daily IV feeds with Cephalexin and calcium, diazepam amongst others. He seemed fairly alright the first two days, it was only on the 3rd day that we noticed he appeared rather "subdued", quiet, not he's normal fiesty self. By the 4th day ,he was lying down the whole time and didnt seemed to respond to us. We attributed this to possible lethargy and medication. The next day, his blood tests were normal and after a cursory examination he was declared fit for discharge despite the fact that by now he could not even stand up or move, we bascially had to carry him into his carrier to be brought home. We reached home in the mid afternoon and put him in the room, again we had to carry him out of the carrier. From the time we reached home right until 10 pm, Tobi condition just deteriorated, once in while he would sort of jerk himself to another area in the room, Im not sure how he did this as he was immobile from the front quarters, his eyes could not track movement, he was drooling brown liquid and had raspy breathing. We took him back to the 24 hr branch at around 10.30 and the vet on duty arrived about 15 mins later,another blood test was conducted plus a chest x-ray, all looked normal, tests for leukemia and FIV was also done, clear as well. At about 11.30am, Tobi convulsed, expelled fluid and stopped breathing, we had opted for DNR. An immediate autospy was done, organs again were all fine. Nobody seems to have an answer for his death.
Needless to say, we are extremely saddened as well as puzzled by his sudden demise, more so when he was brought in for what ought to be a routine treatment for am inflamed penis. Instead five days later, we are having to cremate him. We have since search everywhere for anything information that might explain his sudden death. From what we found, we suspect, of course this may speculative at best, but it appears to be anaphylactic shock ( the question is what was the cause). Again we suspect it could he may have been allergic to one or more of the medications prescibed via the IV drip. Admittedly there could be numerous other possible causes. However we feel it seems to fit the symptoms Tobi displayed - pale gums, immobility, drooling, low temperature, increased heart rate.
We are not ones to assign blame or find fault. Nonetheless, suffice to say we are disappointed with the level of monitoring at the vetirinarian branch Tobi was in. We are well aware that cats are notorious for masking pain and discomfort but honestly to discharge a cat that can't even stand on its feet! It would be like a doctor discharging a patient who can't walk and asking him to go home. While Tobi's blood tests looked fine, a more thorougly physical examination would have raised one or more red flags. From the time of his passing, not one person from the vet had called to offer their condolences or at least offer some theory as to Tobi's death. It's as if that there was no obvious cause, so nobody can be bothered about it.
My wife and I are still coping with his passing but we are doing well. I just thought that since you treated Tobi twice and did such a wonderful job each time, we would like to let you know what has happened since then.
Thank you for taking time to read this long email. Meanwhile, we wish you all the best in your practice and your great care towards all animals, big and small.
P.S. we would have like to gone back to you but the distance was a bit prohibitive. Anyway we thought it would be just a routine treatment but......
Best Wishes & Regards
Name of young couple
EMAIL REPLY FROM DR SING DATED FEB 10, 2012
Hi
I thank you for your compliments and good wishes.
1. You mentioned "a blood test was performed with several struvite crystals detected"? Is it a urine test?
2. What is DNR?
3. Was an X-ray done?
4. Was a urine test done?
Please accept my condolences for the passing away of Tobi. Pl phone me if you have any queries about Tobi as it is easier to discuss on phone than by writing emails.
With best wishes for both of you.
Thursday, February 9, 2012
870. A 12-year-old Jack Russell coughs fresh blood for last 2 days
This case illustrates the importance of using relevant evidence-based medicine to provide a standard of veterinary care affordable and expected by the sophisticated younger generation of Singaporeans. This google generation knows much more than the baby-boomer generation and wants answers quickly as to what is the cause of the problem with their sick pet. Not more than one visit will be the best as Singaporeans are time-pressed.
Yesterday morning, I was the vet on duty. A young man came with his 12-year-old Jack Russell which was in excellent body condition. "He coughs blood in the last two days."
The dog's gums were slightly pale. Rat bait poisoning? Unlikely as the dog was supervised when outdoors and there were no rat baits used in the apartment. This was a much loved dog as he would try and attack the newspaper delivery man every morning but not his family members and the family's friends. He was a puppy when the young man was in Primary 5 or Primary 6 and now 12 years or more had flown by.
"Is he a scavenger?" I asked as the Jack Russell started coughing when I palpated his throat from the larynx downwards. The dog coughed and retched. Fresh red blood with white mucous came out from his mouth onto the floor of the consultation room.
"Yes, he swallows any food he would find in the house." the young man asked me for tissue to clear the mess.
"Is he like my son's Bichon who waits for some chairs not pushed inside the dining table to jump onto the table to eat the chicken bones?"
"Yes, yes, he is like that!" the man said.
"As the throat is so painful, it is possible that there is a chicken bone poking the throat and causing coughing and bleeding. I will need to X-ray the throat, lungs and stomach area."
The owner must be given the advice and if he does not want the X-rays, this must be recorded in the case sheet. He wanted the X-rays and complete blood test.
"My dog had a fierce cancerous lump removed from his neck skin at another vet clinic," the owner said to me. He phoned the vet and they faxed over the report in the afternoon. It was a sebaceous gland carcinoma which had grown red and fast on the dog's lower neck 2 years ago. The skin in that neck area was hairless but no recurrence of tumour was seen.
So, was this a case of chicken bone trauma or not? I got the X-rays done. "Pleural effusion," commented two vets as the X-ray of the lung showed radio-opacity instead of black spaces as for normal lungs. Based on clinical signs and the history of a cancer as well as diffuse nodules seen on the X-ray, I advised the owner that it was most likely metastases of cancer cells to the lungs. Bronchoscopy and lung biopsy could be done but this would add to the cost.
The owner decided on euthanasia and was present when I administered the injection. It was sadness in the evening but he was satisfied with the evidence-based medicine done. If the vet had just given some injections and drips without advising X-ray, this coughing of blood would continue and the owner would become much unhappy with another visit. Therefore, the vet must know what to do in a case of coughing blood. In retrospect, this dog had been coughing for the past year but had not coughed blood till the last 2 days.
Blood test revealed an increase in total white cell count suggesting a bacterial infection, red blood cells and haemoglobin in the lowest range of normal values, suggesting blood loss probably from the lung bleeding. I explained the findings to the owner. He had to decide what to do further.
The diagnosis of tumours in the lung due to metastases from the sebaceous gland carcinoma is quite possible. Veterinary costs need to be minimal so I did not suggest bronchoscopy and lung biopsy to confirm the lung tumours as this would prolong suffering in this dog. Coughing of fresh blood is very likely from the lungs as the amount was much more and persistent.
Yesterday morning, I was the vet on duty. A young man came with his 12-year-old Jack Russell which was in excellent body condition. "He coughs blood in the last two days."
The dog's gums were slightly pale. Rat bait poisoning? Unlikely as the dog was supervised when outdoors and there were no rat baits used in the apartment. This was a much loved dog as he would try and attack the newspaper delivery man every morning but not his family members and the family's friends. He was a puppy when the young man was in Primary 5 or Primary 6 and now 12 years or more had flown by.
"Is he a scavenger?" I asked as the Jack Russell started coughing when I palpated his throat from the larynx downwards. The dog coughed and retched. Fresh red blood with white mucous came out from his mouth onto the floor of the consultation room.
"Yes, he swallows any food he would find in the house." the young man asked me for tissue to clear the mess.
"Is he like my son's Bichon who waits for some chairs not pushed inside the dining table to jump onto the table to eat the chicken bones?"
"Yes, yes, he is like that!" the man said.
"As the throat is so painful, it is possible that there is a chicken bone poking the throat and causing coughing and bleeding. I will need to X-ray the throat, lungs and stomach area."
The owner must be given the advice and if he does not want the X-rays, this must be recorded in the case sheet. He wanted the X-rays and complete blood test.
"My dog had a fierce cancerous lump removed from his neck skin at another vet clinic," the owner said to me. He phoned the vet and they faxed over the report in the afternoon. It was a sebaceous gland carcinoma which had grown red and fast on the dog's lower neck 2 years ago. The skin in that neck area was hairless but no recurrence of tumour was seen.
So, was this a case of chicken bone trauma or not? I got the X-rays done. "Pleural effusion," commented two vets as the X-ray of the lung showed radio-opacity instead of black spaces as for normal lungs. Based on clinical signs and the history of a cancer as well as diffuse nodules seen on the X-ray, I advised the owner that it was most likely metastases of cancer cells to the lungs. Bronchoscopy and lung biopsy could be done but this would add to the cost.
The owner decided on euthanasia and was present when I administered the injection. It was sadness in the evening but he was satisfied with the evidence-based medicine done. If the vet had just given some injections and drips without advising X-ray, this coughing of blood would continue and the owner would become much unhappy with another visit. Therefore, the vet must know what to do in a case of coughing blood. In retrospect, this dog had been coughing for the past year but had not coughed blood till the last 2 days.
Blood test revealed an increase in total white cell count suggesting a bacterial infection, red blood cells and haemoglobin in the lowest range of normal values, suggesting blood loss probably from the lung bleeding. I explained the findings to the owner. He had to decide what to do further.
The diagnosis of tumours in the lung due to metastases from the sebaceous gland carcinoma is quite possible. Veterinary costs need to be minimal so I did not suggest bronchoscopy and lung biopsy to confirm the lung tumours as this would prolong suffering in this dog. Coughing of fresh blood is very likely from the lungs as the amount was much more and persistent.
869. Update: Miniature Schnauzer with recurrent urolithiasis
Recurrent urolithiasis
1. First time - calcium oxalate stones
2. Second time (now) - struvite stones
If the owner is careful and listen to veterinary advice, this case can be prevented using dietary management (prescription diet), monthly urine testing and 3-monthly X-ray of the bladder.
However, most Singaporean dog owners don't bother with the monthly urine testing and X-ray though some do come for the prescription diet.
In one male Miniature Schnauzer dog that I mentored a vet in his first urinary bladder operation of his vet clinic assistant's dog (see Toa Payoh Vets - Dogs - Urinary problems), this dog is fed commercial dry dog food which is less expensive than prescription diet, there is NO recurrence even a few years after surgery. The clinic assistant does not bother with all these advices of monthly urine tests and 3-monthly X-rays!
Website with updates and pictures at:
http://www.sinpets.com/dogs/20120218recurrent-urolithiasis-urinary-stones-calcium-oxalate-struvites-toa-payoh-vets_Singapore_ToaPayohVets.htm
Subscribe to:
Posts (Atom)