1070. Fractured molar in a Golden Retriever - email research

E-MAIL TO DR SING DATED MAY 9, 2012

Dr Sing,

I have started some preliminary research and it seems the procedure we are looking at is called "vital pulpotomy with pulp capping". It is outlined on this vet website
http://www.mypetsdentist.com/site/view/113265_VitalPulpotomy.pml

You can access the site as a vet, by contacting them for a password or something.... I have also written an email to them asking if they are willing to work via correspondence with us... I am not sure how they seal up the one that is fractured all the way up though - wouldnt the risk of infection still be there?

Here is what they had to say about Summer's type of injury -

http://www.mypetsdentist.com/site/view/113061_BrokenTeeth.pml
I spoke to a vet tech friend in the US and she said most likely we will get the best outcome if you can try and contact a vet directly? She said they are more likely to help rather than if I wrote to them.. I will continue doing my homework and research though!

Thanks!


E-MAIL FROM DR SING DATED MAY 10, 2012

Dear C..
It was great to meet you in person after our e-mail correspondence regarding the rescue group who had a stray dog with tick fever of Babesia gibsoni that your first vet said that imidocarb would not be effective and only with the use of the expensive Atovaquone and azithromycin would cure this dog. You got the dog treated by a sponsor of an online request for help and the second vet had successfully treated it with imidocarb with two injections and the dog is now healthy.
Thank you for your detailed research on the dental procedures for your naughtly young Retriever who has fractured both upper pre-molars 4. Singapore does not have a veterinary dental specialist and your research on procedures will be most helpful and useful for Singapore dogs with similar problems. Dental extraction has been advised by vets you had consulted. Your dog's right upper premolar is definitely sensitive as the pulp is exposed partially.
You live in a golden age where internet info is easily available if a person takes the time and trouble to research on a specific medical or surgical problem. We will plan what to do with your Golden Retriever's fractured premolars within 14 days and after you have completed your research. Thank you for doing the research.



E-MAIL TO DR SING DATED JULY 10, 2012

Dr Sing,
After much research and corresponding with both human and dog dentists, the results were disappointing. 2 canine dental specialists said that without a root canal the results would not be good in long run, and human dentists all expressed doubts that a simple filling would hold. We probably would need to make a crown. Too expensive and not practical.
Over the past 2 months Summer has had no trouble eating her usual kibble or even chewing treats. I have been brushing her teeth regularly to maintain hygiene etc. The tooth on the left is looking healthy and fine, except for the small exposed inside. There is no pain. The molar on the right which is fractured to the root has died. It is discoloured gray and has yellow plaque covering it. It has a slightly unpleasant smell.
I think it is best at this point if we were to extract the worse cracked molar on the right side, but leave in the left since it is working fine. What do you think?
We would be honoured if you could carry out the operation. How much would it cost? Can we schedule it this week? As soon as possible.. I am having just a 1 week break now, and then back to school full time with no more breaks till end of the year.

Thank you. Look forward to hearing from you..

E-MAIL FROM DR SING DATED JULY 10, 2012 

I think you should do much more research on "simple filling" as I believe that is the answer to your dog's fractured molar. This is based on my personal experience. I had a large mercury amalgam filling when I had big cavities in my molar some 50 years ago

The filling is still around and my molar is still OK (filling has not dropped off although I know that some people had their fillings dropped off). Now, it is 50 years later. There must be great advancement is this area and it is up to you to find out in more depth and do more research.

Extraction of a good strong molar tooth in a big breed is extremely difficult and may lead to fracture of the jaw bone. So, it is best done at the last resort. Do more research on different types of "filling" found in the world of human dentistry as if you are doing a PhD, and let me know as soon as possible.

It is no longer a good strong tooth as it is dead - has discoloured to grey and does not smell good as compared to the other side which is doing fine with no treatment.. I don't think it's salvageable.. Unfortunately as a student I don't have a couple of hundred to "try out"..


E-MAIL TO DR SING DATED JULY 11, 2012

The canine dental people whom I spoke with said its not about the type of filling but the tooth. First a total root canal would need to be performed, and for a filling to stay a specific shape has to be drilled. Then, because the fracture is all the way to the root, a metal crown should be made.
I'm not looking to remove both, only the rotten one..

Currently she is able to enjoy whatever food she wants, attempting a filling would also unduly hamper that and limit her to soft foods for fear of damaging it..

I'm looking to have the extraction done by this week as it is my only break for a long time and id like to be home with her after..

Thanks for your help!


UPDATES WILL BE AT:
http://www.sinpets.com/stories/20120435dental-fracture-premolars-fourth-golden-retriever-toapayohvets-singapore_ToaPayohVets.htm

1068. Sunday Jul 8 2012's interesting cases

Sunday Jul 8, 2012
Bright, sunny, blue skies

1. Shih Tzu review. Came 3 days ago for two eyes with ulcers and eyelid discharge indicating that the owner was unable to provide post-tarsorrhaphy eye care. Hospitalised. Today, I stained fluorescein. Eye ulcers had healed more. Continue treatment at Toa Payoh Vets

2. Roboroskvi with large inguinal lump 8 mm x 8 mm x 6 cm.
I noted that this aunty came all the way from Bukit Batok with this sleepy Roboroskvi, female, 11 months old. "My niece referred you to me," she said. "She had a robo with grey cement discharge and it was treated by Dr Daniel."
"What happened to it?" I asked.
"OK, but the backside hair did not grow back."
Her Robo was so quiet that I suspected that it was extremely ill. Normal 11-month-old robos are like rockets. They don't stay still at all. The large tumour was hard and maroon, probably a malignant bleeding breast tumour with blood. It died peacefully sitting up and I told the owner the bad news at 5.10pm. Always check the underside of the hamster as tumours are quite common in this area.

3. The driver's Lab Retriever was panting hard last night. He was treated 10 days ago by Vet 1 who did not open today. The wife remembered me from 20 years ago when I treated her dog. "Has he a swollen abdomen," I said. "He lost weight, so the abdomen looks swollen," the husband said.
Vet 1 suspected leukaemia based on blood smear but CBC was not possible due to machine breakdown. He also told the owner that the dog ought to be neutered as it had prostatic hypertrophy. "He put a finger into the rectum," the husband said. "He advised me to neuter the dog."
So what's wrong with this dog?

Vet 1 faxed over the case sheet but he did not do the CBC although he did the biochemistry. He treated with Tardak injection and so I presumed he diagnosed prostrate hypertrophy or prostatitis. But I could not feel any prostate pain or enlargement. I asked Dr Daniel to do a digital rectal examination. He said there was no prostate enlargement. "It could be that Tardak injection had worked," I explained.

The owner did not want to pay for any blood test or X-ray of the chest. I examined the heart (left pulse weak, mitral valve sounds needed further examination.  I palpated the abdomen (spleen slightly enlarged) but no pain in the prostate. No fever.

I took a blood test for examination using the grant for such cases.

4. A lady brought a very thin 16-year-old Shih Tzu, not spayed with 4 breast tumours for antibiotic jab. The dog vomited and had some fits. "It is towards the end of her natural life," I said. So there was no point in advocating dental work as the teeth were all fully plugged with tartar. She went home after treatment by Dr Vanessa. Shih Tzus at 16 years old are extremely old.

1067. The 3-legged dwarf hamster lived to a ripe old age

E-MAIL TO DR SING DATED JUL 4, 2012


Hi Dr Sing,
Poppy didn't wake up this morning.

She will be missed.

Thank you for all your help.

Regards,
Name of owner

----------------------------------------------------------------------------------------------
HISTORY

Poppy, the dwarf hamster would never have survived without the kindness and loving care of the slim lady with black frame glasses. I guess it was the internet who introduced her to me as she had consulted Vet 1.

By then, Poppy had a rock-hard 10-cent coin tumour in her left hind leg. It started as a small lump and the owner had gone to consult Vet 1. For some reasons, Vet 1 did not operate. The lump grew and grew to a 10-cent coin.

"Amputation of the leg is the only option to save her," I advised. There was the risk of the hamster dying under general anaesthesia. But she pulled through. This case is described somewhere in www.toapayohvets.com

Only 2 weeks before she passed away, I removed a small fatty tumour. The owner was very careful and observant and would take the hamster to see me whenever there was a slight medical problem. The hamster lived past 2 years 11 months. It still maintained 24 g as the owner had also got a weighing machine.

SOME OF OUR E-MAIL CORRESPONDENCE

On Oct 13, 2011, at 7:27, Dr Sing wrote:
Thank you for video. Despite left hind leg amputation, the hamster is active. Twitching seen by you may be similar and due to the "phantom pains" that occur in a person that has his leg amputated.Is she putting on weight?

On Thu, Oct 13, 2011 at 12:42 PM, owner wrote:
No, still 28g.
On Fri, 14/10/11, Dr Sing wrote:
How about the itchiness? Try to hand feed and a drop of pred per day. May be experiencing pain of the amputated leg.

On Mon, 17/10/11, owner wrote:
Subject: Re: Poppy
To: "Kong Yuen Sing"
With the Pred, she is more active and also eats more. Seems to like pumpkin seed puree. This morning, she weighed 30g. Scratching right ear again -- have re-started the ear drops. May also need to re-start the skin wash.

On Sat, Oct 22, 2011 at 11:48 AM, owner wrote:
She's active and still on Pred, 0.01/day. But her weight is down to 27g again. Now she won’t eat pumpkin seed puree. Doesn’t eat much of the sunflower seeds, pellets etc either. Seems to eat only tiny bits of veggie (kai lan, carrots, corn, bean sprouts, French beans). What can be used to supplement her diet? Boiled potatoes? rice? egg? Thanks.

E-mail from Dr Sing Sunday, 23 October 2011, 0:56
Subject: Re: Poppy
Could be some internal organ failure due to old age, pain or infections. Please give baytril antibiotics and do hand feeding the mash pelleted hamster feed and seeds 6 times a day in small amounts.



CONCLUSION
With excellent loving nursing care and with trial and errors for feeding, the owner changed diet from processed seeds and pellet to leafy vegetables and maize (see image) over the months. We gave anti-inflam drops. She switched to a less irritating brown paper bedding, the dwarf hamster survived to a ripe old age, weighing 24 grams, losing all hair but was not intensely itchy. The stool pellet was large and good consistency indicating that this hamster ate and passed away peacefully.


 

1066. Learn, Earn, Return? Giving back to society

E-MAIL TO DR SING DATED JUL 8, 2012

Many times  I encountered interesting clients. One was a young lady who brought an orphan baby rat of a few days old for treatment one early weekday morning. Nowadays, I am in the Surgery from  8.30 am to help Mr Min and to do my email replies.

The rat was gasping and I knew it had inhaled the milk given since the lady held the rat's head high and gave a syringe of milk. Some milk would have been breathed in, causing pneuomia and the difficulty in breathing now. "There is not much hope of human beings rearing up an orphan rat or puppy of a small breed successfully," I said from experience with the Pasir Ris dog breeders I attended to for some 2 years at one time. "They don't know how to rear the puppy using a syringe.  A milk bottle would be safer and better."

Two days later, I phoned the young lady who graduated from Princeton but I could not contact her. I encouraged her to give back to society since she was given a scholarship and had a chance to study in a top American University. But how would she do it? Create and share knowledge via a blog or website on some niche areas of interest to the public.

Today I was surprised to receive her email.
------------------------------
  
Jul 8, 2012
Hi Dr. Sing,

I hope you are well!


I'm the girl who brought in the baby rat two weeks ago. I'm sad to say that the rat did not survive... But at least it had a few more days of life from the day I brought it home. It got to open its eyes to see the world and sleep in human hands. :)  I will be going back to the US on 16 July and will update you when I start a blog. It will probably be related to the work I will be doing in the US at the Housing Development Fund. In any case, I will be keeping up with your blog too.


Take care,

 -------------------------------------

E-MAIL REPLY FROM DR SING DATED JUL 8, 2012.

It is good to have met you and to know that you could help the baby rat. Most likely, the baby rat had got aspirational pneumonia from human feeding of syringe. Failure to rear new born puppies with syringes and subsequent death is commonly reported as many people are inexperienced in feeding very small orphan newborn puppies, from my experience with Singapore dog breeders.
.
On another matter, please let me know what are the 3 words from this US investment banker's family.
Something like "learn, earn, (give back to society)". Is it learn, earn, burn?

Giving back to society does not need to be after you have "made" your money, as in the case of the U.S investment banker who is giving educational grants to many undergraduates. Any individual who has benefitted from a University education and scholarship can give back to society immediately by "adding value to the employer" in research on the employer's industry as what I did for the Singapore Turf Club's "reversing the decline in racing" task force publication of my article in the Bmagazine or by means like educational blogs.

Best wishes.

1065. KPI for a Maltese spay done by me

An efficient and not protracted surgery is important for the safety of the animal and for the productivity of the surgeon. Surgical audits need to be done but I have to publish some bench-marks by operating myself.

Spay of a small breed should be less than 20 minutes. One of my cases is  shown in the image. It takes 19 minutes to operate. Overall, the process takes 33 minutes. The lady owner in her late 40s and her mother had gone to the temple to pray for a good outcome.

During surgery, there was some bleeding as the ovaries were abnormal. Probably polycystic.

This dog has false pregnancy at around 3-monthly and even produced milk at the 26th day after spay.

   

1065. Tarsorrhaphy - Poor post-op eye care by owner

The Shih Tzu is the most common breed in Singapore getting eye injuries. It is also the most popular breed purchased in the past years.

Many Singapore dog owners are unable to provide proper post-op eye-care. It may be better to get the dog hospitalised 3-14 days to achieve a good surgical outcome. Compare the two cases. The Pekinese is well cared for because the mother is experienced in dog care and the dog is very easy to handle. The Shih Tzu was not cared for well.

Details of the case are at:

http://www.sinpets.com/dogs/20111214tarsorrhapy-stitch-breakdown-7days-dog-at-home-tips-singapore_ToaPayohVets.htm

I have introduced the Standard Operating Procedure for all cases:
http://www.sinpets.com/dogs/20120706tarsorrhaphy_standard_operating_procedures_toapayohvets.htm

1064. Standard Operating Procedure - corneal ulcer + tarsorrhaphy in the dog

I have written a SOP for vets in Toa Payoh Vets as regards the diagnosis and treatment of corneal ulcers in the dog.





Standard Operating Procedures - Eye Corneal Ulcer & Tarsorrhaphy
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
06 July, 2012   toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129 A video will be produced by Toa Payoh Vets

1. Examine the dog's eyes in detail including ophthalmoscopy. 
2. Fluorescein eye stain test on both eyes is mandatory for all eye cornea injuries. Record extent and depth of the ulcer and surrounding areas and take digital images (side view and front view) of both eyes showing the results of the fluorescein eye test. 
3. If the eye ulcer is not infected, is recent (less than 2 days),  >3mm in diameter and is a deep ulcer, advise tarsorrhaphy or 3rd eyelid flap.
4. If there is infection, wait for 3 days before attempting tarsorrhaphy.
5. AMA - Against Medical Advice. Write in the case file your advice for tarsorrhaphy if the owner does not accept your advice and just want some eye drops and the e-collar.
6. Superficial and small ulcers <3mm can be treated with eye drops and e-collar.
7. Conjunctival flap may be necessary if the ulcers are large.
8. A 3rd eyelid flap and tarsorrhapy may be useful in cases of extensive and deep ulcers but there is the problem of not being able to apply the eye drops.

Tarsorrhaphy.
1. Clip hair off face esp. around the eyelids and facial area.
2. Clip off all hairs from the eye lids.
3. Sedation and general anaesthesia.
4. Forceps to lift up 3rd eyelid. Use a 10 ml syringe to flush debris and dirt from inside the 3rd eyelid.
5. Thoroughly irrigate the eye with clean water a few times.
6. Subconjunctival injection of antibiotics and minimal anti-inflammatory at two spots on lower and upper eyelid.
7. Apply antibiotic eye ointment liberally before sewing the eyelids 
8. Sew up the eyelids with 3/0 absorbable sutures or 3/0 nylon. Two horizontal mattress sutures to evert the eyelids.
9.  Leave a 3-mm gap at the medial canthus for eye-drops.  
10. Three eye drops 3 times/day and clean off discharge for the next 14 days.
11. Stitch removal 14 days later.   

Post-op
1. Ward the dog for at least 3 days. I prefer 10-14 days as most Singapore dog owners are unable to crate the dog and provide proper eye care.
2. Prescribe 2 bottles of eye drops (not one bottle) if the dog goes home on Day 3.
3. Prescribe  pain killers for 4 days.
4. Follow-up 3 days post-op. Record in your case file your follow-up with the owner 3 days after the op to check if the eye-care has been done properly. If the owner complains of eye discharge and dry exudate, advise the owner to bring the down back as the owner is not able to provide good nursing care. Record this advice given in your case file and also not being able to contact the owner by phone. You can send an text message instead. 

Repeat tarsorrhapy
Wait for 3 days before attempting repeat tarsorrhaphy as the eye is usually severely inflamed and infected due to poor eye care and nursing by the owner. Ward the dog for the next 10 days.

Poor post-op nursing care at home.
One case is at: tarsorrhaphy - Against Medical Advice.
 

5448 - 5450. Tarsorrhaphy - Against Medical Advice. The owner is unable to provide proper post-op nursing care at home and the right eye ulcer did not heal uneventfully as the left eye ulcer.

The webpage is:
http://www.sinpets.com/dogs/20111214tarsorrhapy-stitch-breakdown-7days-dog-at-home-tips-singapore_ToaPayohVets.htm

9. As at July 6, 2012, Singapore does not have resident approved veterinary eye specialists. It may be wise to refer the case to other vets if you don't wish to perform tarsorrhaphy, 3rd eyelid flap or conjunctival flap and deal with its post-op complications.

10. Some cases are illustrated in Eye Problems seen at Toa Payoh Vets. The webpage is at:
http://www.bekindtopets.com/animals/20081201PAGE3_Dog_Surgery_Anaesthesia_Eye_ToaPayohVets.htm

11. One case where the mother experienced in keeping dogs, takes excellent care of the Pekinese is shown below.

UPDATED WEBPAGE AND MANY MORE IMAGES
ARE AT:
http://www.sinpets.com/dogs/20120706tarsorrhaphy_standard_operating_procedures_toapayohvets.htm

1063. Medicine for stray dogs and cats in Cambodia

Hi, I'm Agnes. I was in Siem Reap, Cambodia recently, distributing stationery, clothes and food to the children.
I'll be visiting again from 27th July to 5th August. The purpose of this email is to enquire if you would be able to donate some much needed medicine to Katie, the only Western vet nurse in Siem Reap, she's rescuing and treating dogs and cats on a voluntary basis. I can link her up in the email if necessary, she's requesting the following:


Drontal worming preparation
It’s in tablets – for deworming cats
Over the counter
Nutrigel (vitamin paste/syrup)
It’s for dogs and cats
Over the counter
Calcium in the form of small bones
For dogs
Over the counter


Clavulanic acid/amoxicillin (clavulox) 50mg
It’s in tablets form. It’s an antibiotic for cats
On prescription? Over the counter?
Cephalexin 50-60mg
It’s also in tablets form, and also an antibiotic for cats
On prescription? Over the counter?

Hope to hear good news, thank you!


Regards
Agnes


E-MAIL REPLY FROM DR SING DATED JUL 6, 2012
I am Dr Sing from Toa Payoh Vets. We spoke today. There are generic drugs which can be used rather than branded ones as requested by Katie and are much less expensive when sourced from Thailand.
Pl ask the vet nurse to contact me by email and let me know more about her work with stray dogs and cats. 

1062. Acute tick fever in a big white dog in Singapore

1062. Acute tick fever in a big white dog in Singapore July 4, 2012 Wednesday Deaths of pets are part of my veterinary work since I graduated in 1974. Yet, after almost 50 years in practice, I feel much sadness in the death of this beautiful snow-white big dog that died 4 hours after arrival in my Surgery yesterday, despite treatment and fluid therapy. She was middle-aged and quite plump, as cuddly as a miniature polar bear. Not a brown stain on her white coat. No skin disease unlike some others. I had taken a blood sample and did the tick-fever test for Babesia and Ehrlichia. The cause of death was babesiosis (identified as Babesia canis by blood smear), known as tick fever. The Ehrlichia test was negative. "Would she have lived if Vet 1 had diagnosed her with tick fever 8 days ago?" the lady in her 40s had been referred by her brother to consult me thinking that her dog had liver failure and no chance to live. I had told her that liver diseases are not a death sentence but it may be cured if the liver is infected. Vet 1 had given her many liver supplements and so she presumed her dog had liver disease. "It is hard to say whether your dog would have lived if she was diagnosed as having tick fever instead of liver disease 8 days ago," I replied. Babesiosis is a direct and an immune-mediated haemolytic anaemia. The immune response is said to be more lethal than the parasites (merozoites or piroplasm) inside the red blood cells. "Why didn't you consult Vet 1 if your dog is not well after 2 days of medication?" "Vet 1 did not tell me to do that," she replied. "He gave me 14 days of the green tablets (doxycycline 100 mg/tablet), to give two tablets two times a day and other medicine. But my dog stops eating and drinks little yesterday. She was unable to stand up. She vomited brown stuff and passed black stools and brown urine. So, my brother asked me to consult you." "The antibiotic you gave is ineffective against babesiosis," I said. "Your dog needed the anti-tick fever injection." "Why didn't Vet 1 diagnose tick fever?" she asked. "In his case sheet faxed to me, he did write 3 diseases. They are pyometra, tick fever and liver failure." "Why didn't he treat for tick fever?" she asked. "He has written that you did not want the tick fever test to be done. So, it is your decision." "Why didn't he tell me that I should do the tick fever test? Why did he ask me to take the antibiotics for 14 days first?" "He did advise you about the test and had written down in his case sheet that you did not want the test done," I said. "It is up to the owner to decide as the owner pays for the test." "Then why he did the blood test and the blood smear for? The ultrasound too." "He did the blood test to screen the health of your dog esp. the liver and kidney functions. Your dog had been sick for one week before you saw him. The total white cell count was high. The platelets, red blood cells and haemogloin were lower than normal. "But the values were not excessively high," the lady said to me. "So, there was not a big worry." I noted that Vet 1 had written "refractile inclusion bodies seen in the red blood cells." This seemed to give a clue that it was possible that the red blood cells had Babesia parasites. However, a blood smear with the stains would reveal the parasites.  According to Dr Daniel, the blood smear under Gram stain showed lots of red blood cells with Babesia inside.  But the owner had not wanted the "tick-vector test" and so the dog went home with liver medication, anti-abdominal fluid swelling (ultrasound had detected abundant fluid which was sucked out and examined by Vet 1) and vitamins. "My dog could hop into the car when I brought her to see Vet 1," the lady said. "Now she just lay on her chest and refused to stand up." "What is her normal sleeping position?" I asked. "Belly up, like people," she said. Eight days had passed. My blood test showed kidney failure, elevated liver enzymes, a very high total white cell count of 46 as compared to 20 when tested by Vet 1. The normal range is 5-17). The platelets were 26 as compared to 166 earlier (200 - 500). Red blood cells were much lower. "What are the purplish spots on her belly?" the owner asked me when she came to see the dog at 9 pm yesterday. The dog had passed away at around 7 pm.  "Those are areas of skin bleeding as the platelets are very low," I said. "Your dog had difficulty breathing and vomited blood before she passed away peacefully." The dog first showed lethargy 15 days ago. The owner said that the dog had never gone downstairs and had never got any ticks for the past 6 years. Since this dog was so well groomed and never went downstairs, I could believe her that the dog had no exposure to ticks. "Did the dog go to the groomer?" I asked. "Yes, 2 months ago," she said. "I brought her to a new groomer. But she had no ticks on her body when she came back from the groomer." "Why didn't you go to the old groomer?" I asked. "He has stopped grooming since his groomer left." "It is a strange case as a dog must be bitten by an infected tick to get tick fever. Since you were so sure that your dog never had ticks, Vet 1 might have ruled out a high possibility of tick fever infection and went for liver failure diagnosis." CONCLUSION In many cases, owners do not want laboratory tests. However, the vet must be forceful in warning the owner of the fatal consequences of tick fever if the dog is not treated early. Refractile inclusion bodies in the red blood cells were the clue as blood parasites like Babesia can cause refractile inclusion bodies to be formed. It might be wise to treat as if the dog had tick fever rather than following the protocol of confirming tick fever, if economic reasons prevail. The interest of the dog is paramount and if the owner cannot afford the test, it may be advisable to strongly advise it being done. Did the vet phoned the owner 3 days after consultation? I believe he had done so and he had recorded in the case file. "He could have added this in after I asked for the medical report," the lady owner had a very difficult time getting the report to be released to me and therefore had her suspicions. What was the cause of death in this dog? Only an autopsy would find the answer but the owner would not want one. The dog was sent for cremation by her relative. As to the possible cause of death, one experienced vet said it was kidney failure rather than liver failure, Dr Daniel told me. As for me, I would say that the immune-mediated haemolytic anaemia reactions of Babesia canis was the primary cause of the dog's quick death rather than the destruction of the red blood cells. Kidney and liver failures were the consequences. My hypothesis is that the reaction caused platelets to be extremely low and the dog would bleed internally to death. In the evening when the owner came, she pointed to several bruised like spots on the shaved abdomen where the first vet had done his "abdominal tap" to take out the peritoneal fluid. "These are bleeding spots caused by the tick fever parasite reactions," I said to the wife. The dog had coughed up some blood before dying. It was one of those unusual cases as the dog was said not to have been exposed to any ticks over the past years as she lived in the apartment and never went done for walks. If there was definitely no exposure to ticks, the first vet was distracted and went for liver failure diagnosis, disregarding the clue of the presence of refractile inclusion bodies in the red blood cells. Singapore pet owners are getting more sophisticated and demanding and therefore, evidence-based medicine and defensive medicine must be practised nowadays. All advices and client's objections to tests and advices must be recorded properly in the case file as a good habit. In this case, medical negligence would not stand in court, I believe, as the vet did advise an anti-tick vector test and the owner had been informed and had objected to it. The burden of proof is on the owner when negligence is alleged and the proof was not there in this case.       UPDATES & MORE IMAGES WILL BE AT:  http://www.sinpets.com/dogs/20120719Babesia_canis_samoyed_toapayohvets.htm

 

1061. Solution to chronic ear problems in the dog: Toa Payoh Vets Video

July 2, 2012

I have commissioned an educational video on the surgery of the lateral ear canal done at Toa Payoh Vets. This video provides some information for dog owners whose dogs keep scratching and is very smelly for many years. The surgery resolves this problem and is shown in the video at:

http://www.youtube.com/watch?v=ycYKJbB4dYM&feature=youtu.be

The surgery is called Lateral ear canal resection.

For more info
judy@toapayohvets.com
+65 9668 6468
www.toapayohvets.com