Monday, October 22, 2012

1150. Rabbit biting herself passes away

The owner phoned to tell me that his 4-year-old rabbit with the jaw abscess in which I took X-rays and treated, passes away in her sleep.

The young couple had boarded the rabbit at a friend's place and she started to bite off her front paw fur and lately her back paw. She was drooling and wet. The jaw abscess was not present and so it was strange that she passed away. She was on pain-killers and antibiotics and had some appetite.

"She started to bite her front legs again," the husband said. "Also her front paws."

Could this be an allergic reaction or infection? It is a mystery.

1149. An Hougang cat scratches her owner

Monday Oct 22, 2012

"It is OK," the young Malay woman smartly dressed in grey, made up well and covering her head with a deep blue head scarf had made an appointment for her cat to spay. She was from Hougang.

She got her left hand scratched as Dr Daniel held the cat while I injected the xylazine+ketamine 0.2+0.8 ml IM.  She had asked me whether she ought to be around while I gave the anaesthesia injection as her presence would calm her cat.

"My cat starts being aggressive when she is taken out of the carrier at the other vet for her two vaccinations," she said.

"It is good idea," I said. "The other female cat I spayed recently went ferocious as a lion inside the crate when the owner left and when we wanted to take her out for injection. In front of the owner, she was OK and cool."

As predicted, her cat hissed. Dr Daniel had prepared the injection. He held the cat by the scruff while the lady talked to the cat. I injected the left side of the muscle quickly.

"Is it done?" the lady asked as the cat swiped her left hand and left a claw mark more than 3 cm long. "Is your hand bleeding?" I asked,
"No, no, it is only superficial."

I was relieved that the cat didn't scratch her face but her presence was most vital to the sedation as the cat was distracted. Dr Daniel put the cat back into the carrier.
"Just close the door," I said as the lady tried to push back the fabric bedding inside. Her cat hissed out and shot another claw at her. This was a 3-year-old cat and it took her 3 years to have the courage to spay her.

"Is she caterwauling?" I asked.
"No," she said. "She caterwauled last month."
Actually cats come onto heat by caterwauling at non-regular intervals and 4 weeks is about the time that ovaries would enlarge and caterwauling would come. During the spay, the ovaries and uterus were much enlarged as a cat on heat and so it took a longer time to spay.

Young cat owners like this lady are more well informed as she knows what caterwauling means and kinder to cats. That was why she did not want her spayed as that would be 'cruel'.


 "Since the cat scratches you so often, have you thought of declawing ," I advised as cat scratches can be infectious and can cause bad scars on a young lady.

"No declawing," she asked me what tool to buy to clip the sharp nails.
"Just buy one of those cutters used to cut chicken bones or hedges," I described to her the tools. "Use the sharp tips. I don't encourage declawing and almost 100% of the Singapore cat owners don't declaw their cats. 



OCT 25, 2012
The owner just phoned at 6.30 pm saying that her cat was panting and meowing. Earlier she could not poop. But the spay wound was OK. "Can she pee?" I asked. "Not today," she said. "My cat was OK this morning." I could hear the cat meowing in the background and asked her to bring the cat down the surgery for examination.

Compared to the cat of the Nepalese couple spayed around the same time and written in an earlier blog, this cat has some strange behaviour 3 days after spaying. The cat of the Nepalese couple was much younger.

1147. Barking dog upsets peace for 96-year-old mother-in-law

Today is Monday Oct 22, 2012. I was at the clinic at 8.30 am and an interesting phone call came in at 8.55 am.

"May I know what this telephone number 6254-3326 belongs to?" the man asked. "I checked the 'internet by typing "SPCA tel no.' and I got your phone number."
"It is Toa Payoh Vets," I said. "It provides veterinary services."

"I just wanted to ask SPCA advice about my barking dog. He disturbs the sleep of my 96-year-old mother-in-law by barking every time somebody walks past the door."
"Is he a male dog and what breed is he?"I asked. "Is he sterilised?"
"He's a Chihuahua cross, male sterilised dog" the man said. "He just keep barking and barking every time somebody passes by the apartment and my mother-in-law can't rest!"

"How come my clinic phone number is displayed when you google SPCA tel no."?" the man told me he was using yahoo.com and that there was another phone number 62875355 shown.

"Dogs are good pet therapy for old people," I said. "The dog keeps the senior citizens company as the adult children usually are away at work. My son's dog barks every time somebody passes by and he still does it if I am not around. I train him not to bark at passers by using a loud commanding voice and he will not do it if I am around. It takes time to train.

So, what was the problem with this owner? The vet must understand the situation. Probably there were neighbours' complaints esp. those who need to work shifts. But an aged mother-in-law may also need peace to rest.

What are his solutions?
1. Re-homing of a 3-year-old cross takes time and is difficult.
2. Giving to the SPCA means euthanasia after a few days if nobody adopts him. "Your wife will be very upset with this," I said as the dog sleeps on the mattress beside the wife. "My wife is unhappy about giving the dog away," the husband confirmed that women are generally kinder to animals than men.

"There is one last-resort solution which involves de-barking surgery," I said. He would talk to his wife.

Barking dogs need early training when they are young. Some older male dogs just can't be trained and they are discarded.    

.



1146. Kenny Rogers at Singapore Indoor Stadium - success tips for young vets

Monday Oct 22, 2012

Yesterday evening, I had an enjoyable evening listening to Kenny Rogers singing at the Singapore Indoor Stadium. Half the Stadium was used and I would say it was 90% full. No young people of less than 30 years were present as they were not born.  Kenny said that his fans were those born before 1960s and those born after 1960s do not know about songs of the 1960s.

Kenny knows how to connect with the audience and get audience participation and singing. If you watch some of you-tube videos of Kenny Rogers, you can learn some wise tips from him on his success and longevity as as singer. He said that you can never be rich as a singer if you think you want to make money. If you sing with your heart, focus and persevere and have some talents, you will succeed were similar advices he gave during his youtube interviews of his 50th anniversary.

The Indoor Stadium's sound system was very bad but the audience enjoyed his performance. "I am waiting for 'Lady'," I thought he would not sing this song as he was finishing his act from 8.15 pmn to 9.30 pm. He sang it last and the audience appreciated it very much.

Readers may like to watch this video at:
http://www.youtube.com/watch?v=4N-D-Yfisn0  


SUCCESS FOR YOUNG VETS


Vets can never be rich if they just operate one clinic and not be a manager-owner of several clinics. Kenny Rogers can sell millions of records but vets cannot operate on millions of dogs and cats. The important thing for young vets to build their name is to be available.

 

If he or she keeps taking holidays or time off every month, more than usual, then owners just go to other vets who are hardworking. So, skills cannot be acquired or honed. Talents may be there, but the heart is not there for the pets and the clients.

So, being a successful vet practice operator is not easy too as there are high overheads of rentals, staff and stiff competition by younger vets who under price their services and talents don't mean much to Singaporeans who are seduced by the brand name and modern external appearance of the waiting room. Kenny Rogers is an example of success as a singer but there are many more are not known. 

Young vets who want to be successful must be available most of the time. Work-life balance is difficult if you want to be successful in your field. It is good for employees who want time for themselves and their families and employ other vets to run their practices. 

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

IMAGE OF SINGAPORE INDOOR STADIUM on 14 Mar 2024.
Disney On Ice performances


 
 
 

 


Sunday, October 21, 2012

1145. KPI Vomiting female Schnauzer - Cystotomy + Exploratory Laparotomy

Yesterday, Sat Oct 20, 2012, I performed the surgery on this vomiting 4-year-old female Schnauzer. Vomiting past 5 days. Not eating. Had 2 bottles of drips before surgery today.

Anterior abdominal pain - dull whimpering sound. Why?  X-ray - a left kidney stone or stomach stones?  Liver enzymes higher than normal.
Bladder pain - struvite stones known and seen on X-ray. Still vomiting prior to surgery white mucus or water and during mask anaesthesia.


ANAESTHESIA
A: Inject sedation drug   10.20am
B: Isofl first given           10.27 am. Mask, then intubate. Dog vomited again.
C:  Isofl stopped             11.37 am
D: First skin incision       10.39 am
E: Completion of skin stitching   11.37 am

E-A = 57 min
E-D = 58 min  (time taken to check out stomach, kidneys visually and remove >10 bladder stones)
C-B = 64 min

SURGERY
1. Exploratory laparotomy. Big incision. Stomach empty. Intestines with some gas. Colon with black streaks inside. Spleen dark red. Liver dark red. Blood spots near to enlarged left kidney (3x normal right kidney - pic taken).  No foreign bodies inside stomach or intestines.  Kidney stones inside the right kidney?  To review X-ray again.

2. Bladder surgery. Bladder chronic cystitis.Wall >5mm thick, dark red, 9 big yellow bladder stones and four smaller ones. Previous bladder surgery scars. Bladder empty, size of quail's egg.
Incision 1 cm long. Stones massaged out. PDS 3/0 x.  1 apposing stitch closes mucosa. 2 layers of inverting sutures. Syringe of saline to flush out any sand.
 
UPDATE 24 HOURS POST OP (Sunday Oct 21, 2012)
Dog Ok. Drinks, not eat. Had passed water (brownish colour). On medication.
No vomiting as at 11.35 am

PROBLEM
Right kidney much swollen and congested capsule (pic taken). Kidney stones and infection?
Total WCC was high, platelets low indicating a septicaemia.
The liver and kidneys

Friday, October 19, 2012

1144. Struvite urinary stones?

Oct 17, 2012

In August 2012, Vet 1 x-rayed the 4-year-old female Miniature Schnauzer's bladder as she could not pee. "Bladder stones again," the vet recommended another bladder operation. The first operation was done. Updated report at:

http://2010vets.blogspot.sg/2012/10/1152-female-schnauzer-vomits-and.html

1152. The female Schnauzer vomits and dribbles urine

"Jurong is too far for me, I live in Hougang" the owner asked me whether he could purchase the medication for his vomiting Miniature Schnauzer in October  that had been treated by Dr Jason Teo in his Jurong clinic in August 2012. This dog had been X-rayed by Vet 1 at another practice and big urinary stones were seen in the bladder. Vet 1 advised surgery to remove the bladder stones.

As the owner had paid $1,800 to Vet 1 for a similar surgery 10 months ago, the bladder stones had recurred again. He did not want another surgery and so consulted Dr Teo at Toa Payoh Vets on a Saturday. He showed me the X-rays from Vet 1 and the stones were several and big.   

"Vomiting has many causes," I said. "Your dog's abdomen is bloated and there is pain in the anterior abdomen as well as in the bladder. I advise an X-ray and blood test."

"I had done the X-ray in August 18, 2012," the gentleman said. "Why don't you prescribe me some medication first?"

I understand that he had spent quite a bit and prescribed him reluctantly. The next 2 days, the dog continued vomiting some time after drinking water. Urine dribbled out whenever she sat down. So, was this a sure case of urinary tract infection involving the kidneys. Infected kidneys cause toxic blood and therefore vomiting. Urinary incontinence due to bladder stones irritating the bladder and infecting it as confirmed by the urine test. Easy diagnosis.
Yet there was this whole swollen abdomen, as firm as a full-blown balloon and causing the dog to wince when I palpated the anterior part as well as the bladder part. So I insisted on an X-ray. Results showed foreign bodies and gas in the intestines.

Tomorrow is Saturday and my day off. I still need to do the surgery to remove the FB as the dog continued vomiting and not eating. The IV drips for the past 2 days sustained her. The blood test showed increased white cell count and neutrophils and reduced platelets. A bacteraemia causing vomiting and possibly death if left untreated. Unfortunately surgery is the only option and highly risky in a sick dog. The man has a 6-year-old daughter.

"Is it possible her toys and possibly necklaces are thrown all over the floor and this dog had swallowed them." 

Tomorrow's surgery will provide the evidence. The wife was most furious, he said to me. I am most worried that the dog may die on the operating table. The owner knew the risks of death as the dog had been vomiting for 5 days and was having a blood borne bacterial infection. The rectal temperature was 37.6 on admission but today it was 38.5 C after IV drips and antibiotics. "I will be doing only the intestinal surgery to remove the foreign bodies," I informed the owner. "Removing the struvite stones will prolong the surgery and increase the risk of death on the op table." He understood.

Report written: Friday Oct 19, 2012  7.35 pm








1151. KPI. Caesarean section - 3 poodle pups

Oct 13, 2012

Poodle, female, 4 years, 5.6 kg  38.5 C

A: No injection of sedation
B: Isoflurane first given                3.51 pm
C: Isoflurane stopped                    4.46 pm
D: First skin incision                     4.00 pm
E: Skin stitched up                           4.47 pm
Total process E-B = 56 minutes to deliver 3 pups
Surgery time E-D = 47 minutes. Assistant Min handled revival of distressed pups.
Isoflurane + O2 gas used  C-B = 54 minutes
 

1150. KPI. Neuter 5kg dog with normal testicles and xylazine

Oct 15, 2012
Chihuahua X, 5kg, 4 years old male, 2 descended testicles. 2/0 absorbable x 1 packet.

A: Injection of xylazine    9.50 am
B: Isoflurane gas first given  9.58 am     Intubate 10.02 am
C: Isoflurane gas stopped      10.12 am
D: First skin incision              10.07 am
E: Skin stitching completed    10.17 am

The whole process  E-A = 27 minutes
Surgery                    E-D = 10 minutes
Isoflurane used        C-B = 14 minutes

IV anaesthesia can be used but with this method, the lady owner was most impressed that her dog was alert and not dopey when she came to collect him one hour later. That is the beauty of using xylazine IM. The use of domitor and ketamine IV does make the dog dopey even some hours after surgery unless the vet gives the antidote Antisedan which my associate vets seldom do.

ECONOMICS
It is much more costly to use domitor + ketamine + isoflurane compared to xylazine + isoflurane but associate and employee vets don't bother about veterinary economics.  

1149. KPI Neuter one monorchid Maltese using xylazine

17.10. 12
Mini-Maltese, Male, 1 year, 2 kg
Right testicle undescended

I used xylazine 0.2 ml IM, then isoflurane by gas and intubated.
Two separate incision of skin areas for removal of the testicles


A: Injection of xylazine   3.45pm
B: Isoflurane + O2 gas given   3.58 pm. Intubated
E: Completion of skin stitching 4.17 pm
PDS 3/0 x 1 pack

The whole process  E-A = 32 minutes.
I wasted some time trying to shift the undescended right testicle to the skin incision made for the normal testicle but it was not possible and to avoid incising the urethra accidentally, I made a separate skin incision. So, the whole process takes longer.

As Domitor was out of stock, I used xylazine IM which I used to do for many years. Now the vets tend to use domitor + ketamine IV at 0.4 ml + 0l5 ml IV for a healthy young 10 kg dog,  after being convinced by me that the combinaton formula was effective and safe esp. if given at 50% and then top up with isoflurane + O2.