Tuesday July 10, 2012, I had a discussion with Video producer Nicole, Dr Daniel, Dr Vanessa and Intern Siti, a 4th year student from Serdang Vet about the diagnosis and treatment of tick fever in dogs, using a real case example referred to me recently but died within 4 hours of arrival. Siti is to present this case in her 5th year and so she was writing up the case. I gave her a day to write the case but she could not do it.
What is tick fever?
What body systems are affected?
When do clinical signs appear from the start of infection?
What should be done to diagnose tick fever is suspected?
The vet had 3 differential diagnosis - pyometra, tick fever and liver failure. His medication indicated that he was treating for liver failure and had given the owner a poor prognosis.
What is most important question to ask in the history if tick fever is to be diagnosed?
What laboratory tests must be done?
What signficant aspects of the tests must the vet look for?
What is the cause of death in this Samoyed?
An autopsy would be needed but the owner would not want it.
Possible causes:
1. Kidney failure according to one senior vet, based on the 2nd blood test.
AMA - Against medical advice. The vet did record in his case file that the owner did not want a tick-vector test to be done. The vet has given his advice but it is up to the owner to accept his advice as the owner pays for the test.
Follow-up. The vet recorded that he did phone the owner 3 days after treatment. That is good practice, but the owner denied having received any call.
Medical negligence - The burden of proof is on the owner. Was this vet negligent? My answer is no.
Wednesday, July 11, 2012
1073. FLUTD and constipation in a cat
Hi Dr Sing, My name is Gary from Vancouver Canada, I really appreciate your blog and it gives me a lot of in depth on animal's medical problems.
I am not sure if you would accept inquiry from general public on Internet, but I would like to give it a try and see if you can drop me a quick notes.
I have a 19 month British shorthair cat. He is male, neutered. As I have learned the hard way, male cats are prong to FLUTD.
Two months ago, he was completely blocked. I took him to local vet here. They unblocked him and put him on prescription diet Hill's S/D for about a month.
He was peeing fine, but the flow was never that strong after catheteration. The doctor prescribe him with some medicine which helps relieve of urethra and it helped him for about a week.
We took him back to the vet for the follow up. He did urine test and found no crystal or inflammation. But around that time, my cat started to dribble during peeing. Doctor did a physical test on his bladder and found it was not big. Therefore we went home and put him on Hill's C/D and monitoring his peeing status. (we gave him more water in the wet foods to increase his water intake)
A week has passed by, he still dribbles. He usually goes into bathroom two to three times and each time takes a long time, it sometimes takes up to 5 minutes, I see urine pass through constantly, but again, it dribbles, not a stream.
We decided to take him to another vet today. This new doctor said his bladder is big, and need to do x-ray and catherteration again. We went ahead with it.
As we discussed about the result of the x-ray, doctor mentioned that he also has constipation problem.
This leads to several of my questions.
1. Ever since my cat got blocked the first time, we fed him prescription diet dry and wet foods with additional water in the wet foods. Why would he get re-blocked and suffer from constipation? I would assume the water intake is enough and it should resolve urethral obstruction and constipation problem
2. what is your opinion on raw foods and all wet foods for cat? From what I read online, it could resolve FLUTD and constipation problem.
3. Would prescription diet such as Hill's c/d and s/d cause constipation? or if doctor prescribe diet to address constipation issue, will it cause future FLUTD again?
4. what is the best diet you would recommend for my cat who suffer from both constipation and FLUTD caused by urethral obstruction?
Thank you in advance for your help. I really hope I can hear back from you. I am just a desperate cat lover who is at loss and seeking help everywhere.
Thank you again and appreciate your time.
Gary
Reply Forward
Gary Chen
2:12 AM (4 hours ago)
to me
-------------------------------------------------
On Tue, Jul 10, 2012 at 10:05 AM, ..@gmail.com> wrote:
Thank you for your email. It is extremely difficult to know what causes FLUTD in a male neutered cat. Before answering your questions, I would like to know the following:
1. Results of urinary analysis and X-ray images taken by your two vets will be very useful.
1.1 Did the first vet's urine test show struvite crystals?
1.2 What does the second vet's urine results show? Do you have the results?
1.3 Any blood test results?
2. What type of cat litter you are using and how often you change the litter?
3. Any other cats in the house?
4. Any new events or pets like dogs introduced recently?
5. Constipation. You will know better whether your cat is constipated if you are the one cleaning up his litter. Is he constipated?
Can you provide the info?
---------------------------------------------------------------------------
Hi Dr. Sing
Thanks for your reply. I am so glad that I can hear from you for 2nd opinion.
I will try my best to answer 1st set of question at this moment, if it's not thorough enough, I will get info my my vet.
1. 1 First vet's first urine test at the time of obstruction, show struvite crystals, therefore he gave him Hill's S/D. After a month on S/D, we went back for 2nd urine test, and the result was negative. but my cat, Maoru, wasn't peeing smoothly
1.2 Maoru is still with the 2nd vet, we will know result of the urine test today or tomorrow
1.3 Blood test was done by first vet, but I could not remember the result. I will have to find out for you
2. Maoru uses human toilet bowl instead of litter box, and we flush right after he uses toilet almost every time.
3. We just lost the other cat last Thursday due to breath arrest.
4. During first obstruction, there was no environment change, but I suspect constipation was a long term issue. Second obstruction slowly getting developed two weeks ago, and we lost our other cat last Thursday
5. yes, He is constipated. he's very inconsistent and irregular. He sometimes goes daily, then we worry less, but he could go every two days or sometimes goes into the third day. His X-ray yesterday did show a lot of feces in his body.
I am not sure if you would accept inquiry from general public on Internet, but I would like to give it a try and see if you can drop me a quick notes.
I have a 19 month British shorthair cat. He is male, neutered. As I have learned the hard way, male cats are prong to FLUTD.
Two months ago, he was completely blocked. I took him to local vet here. They unblocked him and put him on prescription diet Hill's S/D for about a month.
He was peeing fine, but the flow was never that strong after catheteration. The doctor prescribe him with some medicine which helps relieve of urethra and it helped him for about a week.
We took him back to the vet for the follow up. He did urine test and found no crystal or inflammation. But around that time, my cat started to dribble during peeing. Doctor did a physical test on his bladder and found it was not big. Therefore we went home and put him on Hill's C/D and monitoring his peeing status. (we gave him more water in the wet foods to increase his water intake)
A week has passed by, he still dribbles. He usually goes into bathroom two to three times and each time takes a long time, it sometimes takes up to 5 minutes, I see urine pass through constantly, but again, it dribbles, not a stream.
We decided to take him to another vet today. This new doctor said his bladder is big, and need to do x-ray and catherteration again. We went ahead with it.
As we discussed about the result of the x-ray, doctor mentioned that he also has constipation problem.
This leads to several of my questions.
1. Ever since my cat got blocked the first time, we fed him prescription diet dry and wet foods with additional water in the wet foods. Why would he get re-blocked and suffer from constipation? I would assume the water intake is enough and it should resolve urethral obstruction and constipation problem
2. what is your opinion on raw foods and all wet foods for cat? From what I read online, it could resolve FLUTD and constipation problem.
3. Would prescription diet such as Hill's c/d and s/d cause constipation? or if doctor prescribe diet to address constipation issue, will it cause future FLUTD again?
4. what is the best diet you would recommend for my cat who suffer from both constipation and FLUTD caused by urethral obstruction?
Thank you in advance for your help. I really hope I can hear back from you. I am just a desperate cat lover who is at loss and seeking help everywhere.
Thank you again and appreciate your time.
Gary
Reply Forward
Gary Chen
2:12 AM (4 hours ago)
to me
-------------------------------------------------
On Tue, Jul 10, 2012 at 10:05 AM, ..@gmail.com> wrote:
Thank you for your email. It is extremely difficult to know what causes FLUTD in a male neutered cat. Before answering your questions, I would like to know the following:
1. Results of urinary analysis and X-ray images taken by your two vets will be very useful.
1.1 Did the first vet's urine test show struvite crystals?
1.2 What does the second vet's urine results show? Do you have the results?
1.3 Any blood test results?
2. What type of cat litter you are using and how often you change the litter?
3. Any other cats in the house?
4. Any new events or pets like dogs introduced recently?
5. Constipation. You will know better whether your cat is constipated if you are the one cleaning up his litter. Is he constipated?
Can you provide the info?
---------------------------------------------------------------------------
Hi Dr. Sing
Thanks for your reply. I am so glad that I can hear from you for 2nd opinion.
I will try my best to answer 1st set of question at this moment, if it's not thorough enough, I will get info my my vet.
1. 1 First vet's first urine test at the time of obstruction, show struvite crystals, therefore he gave him Hill's S/D. After a month on S/D, we went back for 2nd urine test, and the result was negative. but my cat, Maoru, wasn't peeing smoothly
1.2 Maoru is still with the 2nd vet, we will know result of the urine test today or tomorrow
1.3 Blood test was done by first vet, but I could not remember the result. I will have to find out for you
2. Maoru uses human toilet bowl instead of litter box, and we flush right after he uses toilet almost every time.
3. We just lost the other cat last Thursday due to breath arrest.
4. During first obstruction, there was no environment change, but I suspect constipation was a long term issue. Second obstruction slowly getting developed two weeks ago, and we lost our other cat last Thursday
5. yes, He is constipated. he's very inconsistent and irregular. He sometimes goes daily, then we worry less, but he could go every two days or sometimes goes into the third day. His X-ray yesterday did show a lot of feces in his body.
1072. Update. KPI for a small breed dog - false pregnancy & pyometra
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 by the licensee so as to maintain a high standard of care and build up the reputation of the veterinary surgery. I publish some bench-marks of how long I take to spay a small breed with false pregnancy and one with pyometra
1. KPI for spaying a dog with false pregnancy
1. A: IV inj Dom + Ket: 3.17pm
2. B: Isoflurane gas first given: 3.27pm
3. C: Isoflurane gas stopped: 3.47pm (spay and then dental work)
4. D: First skin incision: 3.31pm
5. E: Skin stitched: 3.50pm
E-D = 19 minutes
E-A = 33 minutes
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 in this case. Just be careful about the false pregnancy milk falling into the abdomen.
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.
No need to return for stitch removal in 99% of my spay cases as the stitches do dissolve and the surgical wound do heal well as in this case. No extra subcuticular stitches are done by me in all spays and so there is less suture irritation and stitch abscesses.
Stitching involves the linea alba and skin only. Keep spay simple and short. No fanciful "hidden SC stitches" to impress the owner but if you want to do it, use an appropriate smaller sized needle and 3/0 suture.
The dog is more "aggressive" after spay. She still produces milk even 26 days after spay. Why? This behaviour is hard to explain as the dog may be protecting herself against dressing changes by the lady owner. She has a history of false pregnancies every 3-4 months and her estrus cycle was not normal.
2. Spaying a dog with pyometra
1. A: IV inj Dom + Ket 10.07 am
2. B: Isoflurane gas first given 10.09am
3. C: Isoflurane gas stopped: 10.51am (spay and then dental work)
4. D: First skin incision: 10.18 am
5. E: Skin stitched: 10.44 am
E-D = 26 minutes
E-A = 37 minutes
A small breed dog or cat spay should be completed (E-D) in less than 20 minutes and (E-A) should be less than 30 minutes.
For pyometra as in the above dog, the time taken is 26 minutes. It takes longer as the womb is filled with pus and extra care and longer skin incision are needed during surgery.
I am still doing a trust and audit check on my vets to make sure that the time spent/spay is not too long due to lack of planning and inefficiency or idle chatting. Employees love to chat and that is part of human nature. However, no chats should be done during surgery as there must be focus on the patient's life. Proper accounting must be done to ensure that the business can survive in this harsh economic environment esp. with the impending world recession due to the euro crisis.
5399 - 5402. Old Chihuahua, adopted from a dog breeder, has open pyometra. The dog recovered with no problem. Recently she had a cough, was treated and had recovered.
CONCLUSION
A database of the process of spays done by associate vets at Toa Payoh Vets will enable me to know the efficiency and productivity of the veterinary surgeons. For example, I have encountered vets using 2 packets and 3 packets of sutures to spay a small and large breed dog respectively. This is not a best practice and the vet has to find out why he or she needs to use more packets when the usual practice is one or two packets.
UPDATES ARE AT:
http://www.bekindtopets.com/20120707key_performance_indicators_dog_spay_toapayohvets.htm
1. KPI for spaying a dog with false pregnancy
1. A: IV inj Dom + Ket: 3.17pm
2. B: Isoflurane gas first given: 3.27pm
3. C: Isoflurane gas stopped: 3.47pm (spay and then dental work)
4. D: First skin incision: 3.31pm
5. E: Skin stitched: 3.50pm
E-D = 19 minutes
E-A = 33 minutes
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 in this case. Just be careful about the false pregnancy milk falling into the abdomen.
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.
No need to return for stitch removal in 99% of my spay cases as the stitches do dissolve and the surgical wound do heal well as in this case. No extra subcuticular stitches are done by me in all spays and so there is less suture irritation and stitch abscesses.
Stitching involves the linea alba and skin only. Keep spay simple and short. No fanciful "hidden SC stitches" to impress the owner but if you want to do it, use an appropriate smaller sized needle and 3/0 suture.
The dog is more "aggressive" after spay. She still produces milk even 26 days after spay. Why? This behaviour is hard to explain as the dog may be protecting herself against dressing changes by the lady owner. She has a history of false pregnancies every 3-4 months and her estrus cycle was not normal.
2. Spaying a dog with pyometra
1. A: IV inj Dom + Ket 10.07 am
2. B: Isoflurane gas first given 10.09am
3. C: Isoflurane gas stopped: 10.51am (spay and then dental work)
4. D: First skin incision: 10.18 am
5. E: Skin stitched: 10.44 am
E-D = 26 minutes
E-A = 37 minutes
A small breed dog or cat spay should be completed (E-D) in less than 20 minutes and (E-A) should be less than 30 minutes.
For pyometra as in the above dog, the time taken is 26 minutes. It takes longer as the womb is filled with pus and extra care and longer skin incision are needed during surgery.
I am still doing a trust and audit check on my vets to make sure that the time spent/spay is not too long due to lack of planning and inefficiency or idle chatting. Employees love to chat and that is part of human nature. However, no chats should be done during surgery as there must be focus on the patient's life. Proper accounting must be done to ensure that the business can survive in this harsh economic environment esp. with the impending world recession due to the euro crisis.
5399 - 5402. Old Chihuahua, adopted from a dog breeder, has open pyometra. The dog recovered with no problem. Recently she had a cough, was treated and had recovered.
CONCLUSION
A database of the process of spays done by associate vets at Toa Payoh Vets will enable me to know the efficiency and productivity of the veterinary surgeons. For example, I have encountered vets using 2 packets and 3 packets of sutures to spay a small and large breed dog respectively. This is not a best practice and the vet has to find out why he or she needs to use more packets when the usual practice is one or two packets.
UPDATES ARE AT:
http://www.bekindtopets.com/20120707key_performance_indicators_dog_spay_toapayohvets.htm
Tuesday, July 10, 2012
1071. Update: The shih tzu with the decomposed dog smell
Sunday Jul 1, 2012 interesting cases
Jul 1, 2012
1. Pekinese with right eye ulcer. Owners had run out of eye drops. Around 10 days since tarsorrhapy done by Dr Daniel.
Eyelid stitches removed. Dr Daniel used fluorescein eye stain. NO more staining indicating ulcer had healed. I took some images of pre- and post-injury corneal ulceration. I will use this as a case study for video production. Excellent surgical outcome in this case. This was because the owner's mother knew how to care for this dog. The eyelids did not have any discharge or dirt on Day 12 when I saw him as contrasted to other dogs with similar problems and being cared for at home. Case is written at: Standard Operating Procedures - Eye corneal ulcer & tarsorrhaphy
2. Foul-smelling "decomposed dog" case Shih Tzu had been warded here for 15 days. No more bad smell. Main problem is an intense ventral contact dermatitis. Dog just had to scratch belly -- traumatic injury and smells. Will follow up.
History. Shih Tzu, Male, Born Sep 2004.
Seen other vets in Dec 5, 2009, Apr 16 10, May 10, 10, Aug 6 10, Oct 31 10, Apr 5, 11, Jul 10 11.
Wanted to send dog to SPCA if I can't cure this "smell like dead dog" lower half of body. "The decomposed dog smell comes back 2nd day after bathing," the serious gentleman told me. "Not all skin diseases in the Shih Tzu are curable," I said to him. "Hospitalise the dog for a few days and let me observe him." The dog had a full coat with no hair loss. Some scales drop off from the lower belly and chest areas which were inflamed. I expressed the anal sacs.
They were filled with dark brown oil and very smelly. The flies appeared from nowhere and landed on this oil when I took the tissue with the oil for photography outside the Surgery. "Can't be the anal sac oil causing this smell," the owner disagreed with my findings and the fact that the flies were so interested in this anal sac oil. Normally, flies don't come at all. My hypothesis was that the oil might have licked out and stained the dog with the smell of dead flesh. The owner was not convinced as he said the groomer and the other vets had expressed the glands. Well, I had the pictures of the flies but it was pointless to show him since he had discounted this as a cause.
Shih Tzu keeps scratching lower body every day
Foul-smelling anal sac oil expressed. Flies appeared from nowhere
I smelt the dog's body on Day 3 of hospitalisation with medication given and skin washes done. There was a faint oily smell but not the decomposed meat smell. "Not that smelly," I said to the owner. But I observed that the dog's lower body was very red. As if the dog had rubbed it or more likely scratched it vigorously. The inflamed neck and groin was seen on and off. So, this was the problem. My hypothesis is that the dog just could not help scratching the lower body, due to conditioned reflexes. He had been scratching it for months as it was a way to relieve the itchiness. Some anal oil would have contaminated this traumatised skin and made the skin much more itchy and infected. So, 2 days after bathing, the rancid dead flesh smell came back.
Altogether, I hospitalised the dog for 14 days. "How much it will cost me?" the owner asked. "Not much," I said. "Since there is no surgery done." After 14 days of medication and washing, I sent the dog home with instructions that he wear a shirt to protect his lower chest and groin. The owner did that and on July 9, 2012, I phoned him. He was very happy as the dog did not smell anymore. Before sending the dog home, I expressed the anal sac. Another lot of dark brown anal oil came out.
This dog was not sent to the SPCA now and should live a normal life much loved by this serious gentleman. Dogs with skin diseases are sent to the SPCA to be put to sleep usually. Skin diseases in Shih Tzus are more common than in other breeds, in my practice experience. It is possible that the busy and time-pressed Singapore owners don't have time to do the daily brushing and grooming. This leads to skin infections and continuous itchiness. Many of these skin disease cases need reviews and strict compliance with medication prescribed. But this owner said that his dog passed blood in the stools when the other vets prescribed oral medication and so he did not do it. He did see 7 vets in 7 times as the vet practice has different vets on duty at times he went.
UPDATE:
Yesterday, July 9, 2012, I phoned the owner to find out the fate of this Shih Tzu. He said: "No smell,"
"Did you buy the shirt for him to wear?" I asked. "Yes," he sounded quite happy. I hope this Shih Tzu's anal sacs don't produce more of the stinking oil again. I doubt the owner will come for review when there was no apparent skin problems!
WEBPAGE:
http://www.kongyuensing.com/animals/20120710shih_tzu_decomposed_dog_smell_toapayohvets.htm
Jul 1, 2012
1. Pekinese with right eye ulcer. Owners had run out of eye drops. Around 10 days since tarsorrhapy done by Dr Daniel.
Eyelid stitches removed. Dr Daniel used fluorescein eye stain. NO more staining indicating ulcer had healed. I took some images of pre- and post-injury corneal ulceration. I will use this as a case study for video production. Excellent surgical outcome in this case. This was because the owner's mother knew how to care for this dog. The eyelids did not have any discharge or dirt on Day 12 when I saw him as contrasted to other dogs with similar problems and being cared for at home. Case is written at: Standard Operating Procedures - Eye corneal ulcer & tarsorrhaphy
2. Foul-smelling "decomposed dog" case Shih Tzu had been warded here for 15 days. No more bad smell. Main problem is an intense ventral contact dermatitis. Dog just had to scratch belly -- traumatic injury and smells. Will follow up.
History. Shih Tzu, Male, Born Sep 2004.
Seen other vets in Dec 5, 2009, Apr 16 10, May 10, 10, Aug 6 10, Oct 31 10, Apr 5, 11, Jul 10 11.
Wanted to send dog to SPCA if I can't cure this "smell like dead dog" lower half of body. "The decomposed dog smell comes back 2nd day after bathing," the serious gentleman told me. "Not all skin diseases in the Shih Tzu are curable," I said to him. "Hospitalise the dog for a few days and let me observe him." The dog had a full coat with no hair loss. Some scales drop off from the lower belly and chest areas which were inflamed. I expressed the anal sacs.
They were filled with dark brown oil and very smelly. The flies appeared from nowhere and landed on this oil when I took the tissue with the oil for photography outside the Surgery. "Can't be the anal sac oil causing this smell," the owner disagreed with my findings and the fact that the flies were so interested in this anal sac oil. Normally, flies don't come at all. My hypothesis was that the oil might have licked out and stained the dog with the smell of dead flesh. The owner was not convinced as he said the groomer and the other vets had expressed the glands. Well, I had the pictures of the flies but it was pointless to show him since he had discounted this as a cause.
Shih Tzu keeps scratching lower body every day
Foul-smelling anal sac oil expressed. Flies appeared from nowhere
I smelt the dog's body on Day 3 of hospitalisation with medication given and skin washes done. There was a faint oily smell but not the decomposed meat smell. "Not that smelly," I said to the owner. But I observed that the dog's lower body was very red. As if the dog had rubbed it or more likely scratched it vigorously. The inflamed neck and groin was seen on and off. So, this was the problem. My hypothesis is that the dog just could not help scratching the lower body, due to conditioned reflexes. He had been scratching it for months as it was a way to relieve the itchiness. Some anal oil would have contaminated this traumatised skin and made the skin much more itchy and infected. So, 2 days after bathing, the rancid dead flesh smell came back.
Altogether, I hospitalised the dog for 14 days. "How much it will cost me?" the owner asked. "Not much," I said. "Since there is no surgery done." After 14 days of medication and washing, I sent the dog home with instructions that he wear a shirt to protect his lower chest and groin. The owner did that and on July 9, 2012, I phoned him. He was very happy as the dog did not smell anymore. Before sending the dog home, I expressed the anal sac. Another lot of dark brown anal oil came out.
This dog was not sent to the SPCA now and should live a normal life much loved by this serious gentleman. Dogs with skin diseases are sent to the SPCA to be put to sleep usually. Skin diseases in Shih Tzus are more common than in other breeds, in my practice experience. It is possible that the busy and time-pressed Singapore owners don't have time to do the daily brushing and grooming. This leads to skin infections and continuous itchiness. Many of these skin disease cases need reviews and strict compliance with medication prescribed. But this owner said that his dog passed blood in the stools when the other vets prescribed oral medication and so he did not do it. He did see 7 vets in 7 times as the vet practice has different vets on duty at times he went.
UPDATE:
Yesterday, July 9, 2012, I phoned the owner to find out the fate of this Shih Tzu. He said: "No smell,"
"Did you buy the shirt for him to wear?" I asked. "Yes," he sounded quite happy. I hope this Shih Tzu's anal sacs don't produce more of the stinking oil again. I doubt the owner will come for review when there was no apparent skin problems!
WEBPAGE:
http://www.kongyuensing.com/animals/20120710shih_tzu_decomposed_dog_smell_toapayohvets.htm
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
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
Sunday, July 8, 2012
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.
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.
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.
Subscribe to:
Posts (Atom)