1186. Haematuria in a British bulldog. Durian seed, bladder stone or a botched up spay?

"Could it be a durian seed? My dog rushed and swallowed one yesterday, before I could stop her," the be-spectacled woman in her late 40s was not fully convinced that the X-ray showed a big bladder stone in the ventral dorsal view was really a bladder stone. Her 4-year-old spayed female British bulldog had peed blood in the urine for the past 2 days.

"There is a lot of food in the stomach and intestines," I said. "It is hard to see the durian seed. Definitely, the stone is a large bladder stone. Have you been feeding dry dog food for the past 4 years?"

"No, I stopped after she was over one year old because the other vet advised me to feed home-cooked food to resolve the skin disease problem. I only gave her the dry food in the last 2 days when she passed blood in the urine. Could it be a botched spay operation done by Vet 1 when she was one year old? When she passed urine, I could see the blood in the urine."

"If the spay had not been well done, the dog would be passing blood without any urine every 6-monthly. The blood would not just be present together with the urination." I said.

"I do not see such occurrences," she said. "How about the durian seed? I forgot to tell Dr Daniel about it earlier."

"There may be a durian seed but it is not seen in the X-ray," I said. "The big mass is the bladder stone in the bladder."

I advised antibiotics for 3 days before surgery. The owner brought her trolley and dumped her Bulldog upright inside it and took her home today. The urine analysis and blood test results are pending. 

1185. Audit Review of skin disease: The black Mini Schnauzer still bites her legs again

Sunday Nov 18, 2012  9.58 am

Skin diseases are due to many causes and each vet has his or her own way of diagnosis and treatment. Some cases need regular reviews monthly but rarely do owners bother to do it. Some cases get cured with one or two treatments. In the following audit case, I review the case treated by my associate vet in more detail as the owner came back again some 3 months later after the first treatment at Toa Payoh Vets on Nov 15, 2012 and as she spoke in Hokkien, I took over the case from the associate vet who could not speak a word of this dialect.

I was present on Nov 15 and saw her male friend shaking his head disapprovingly. "Your husband is shaking his head," I said. "He is a friend. I am a divorcee," she informed me. So, one must not presume spouses anytime. I asked for her history from the previous vet. There were 13 pages of record.

Today Sunday, I phoned the owner at 9.50 am. Nobody answered. Too early for a Sunday morning or she had gone out. Over 50 years old lady.


Mini Sch black, female, spayed

Social media and google docs. Can old dogs learn new tricks?

Nov 17, 2012
To: Young new graduates - marketing your expertise in the social media is hard work
From: Dr Sing Kong Yuen

Use google docs and social media to promote your expertise

The golden age of the internet is here. Yet, most young people don't know how to use the social media to promote their skills for prospective cients.

Gaming is fun and pleasure but will not create awareness of your hobbies, skills and expertise as a vet or hobbyists.

Facebook with pictures of fun and beer drinking and outrageous behaviour of the young undergraduates at school will make the their baby-boomer mothers blush, but actually such images cast the young persons involved as being lacking in self-discipline and morals and demonstrate irresponsibility to hold top management positions to prospective employers.

Use google docs to get your financial statements stored, rather than emailing attachments to the employer. The employer just click on the link with a password. This is what I mean by using social media to be more efficient, productive and smart in your profession.

With the new Samsung Notebook Lte, it is possible to write directly onto the phone-tablet. I can see this as a new way to record case studies by writing instead of typing on the keyboard and then storing the record in the cloud. Typing during consultation takes a lot of time and so this Samsung Notebook with pen will be an advance in medical recording, if you know how to apply the tools of the trade.

Read, research and apply the tools of social media to promote your expertise. It will be dull and boring compared to thumbing text messages to your friends and they thumb back trivial news to you, back and forth during your working hours. It is hard work and requires daily input on the blog, facebook or other social media. Few young ones will do it. So, this is where you distinguish yourself as a professional or hobbyists. Rarely do baby-boomer generation people do it but then they are set in their ways watching TVS or online movies and have no time to learn and apply new technologies to promote their expertise. Well, they are either established in their management positions or about to retire. Why would old dogs learn new tricks?

It is time to change your mindset if you want to distinguish yourself in this extremely competitive world where prospective clients are much more sophisticated and demanding of the highest standard of service at the lowest costs by surfing the internet.

1183. Visual arts - artist

I rarely encounter artists as clients.
One of my clients is a visual artist.
Website
 http://tfcsea.nafa.edu.sg/artist_biography.aspx?id=35

Her father's website

http://tfcsea.nafa.edu.sg/artist_biography.aspx?id=14

Many times, I can't figure out how an artist can earn a living as their art pieces need promotion, marketing, affordable pricing.  Many don't seem to like to draw Singapore River scenes or local cultures as I presume there is no demand.

In some art exhibitions locally at the malls, some of such local scenes are good pieces of art but the prices are over $1,000.

It is time for the new artist to start their own website and display their artwork and pricing. But most don't do it and so the average man can see their artwork and can't buy their art pieces without having to go through an art gallery!  

Lately Singapore has an "Affordable Art Fair". 

Should young practising vets display their "artwork" which would be case studies with photos of before and after so that the prospective clients know what they are skilled at? Well, most don't do it. It is just too much time needed to do it!

1182. Intense scratching of face and neck - poodle case review

Nov 16, 2011

I was reviewing a skin disease case and phoned the retired pharmacist.
"My poodle is OK now. 95% cured. Nibbles at front paws and will stop when I scold him."
"You can't be monitoring him 24 hours," I said. "Did you eat the Z/D diet?"
"He didn't like it, so I mix it with the usual dry dog food,"


Some info

Poodle, M, 4 years, landed property
Fed various brands of dry dog food

May 5, 2012
Itchy face, neck, paws, elbows. Skin scraping - no mites. No ringworm. Ears normal.
Medication and an anti-mite insecticide wash.
No further complaint.

Oct 20, 2012
Went to emergency night clinic.
Uncontrollable scratching of lower night all night until it bleeds.
Blood test normal. Skin scraping fungus and bacteria, no mites.
Hyperpigmented skin on ventral neck and dorsal surface of front paws - suggestive of chronic skin disease. Advised skin allergery/atopy workup.

Oct 21, 2012
Treated for bacteria and fungus. Canine Z/D trial for 3 months accepted by owner.
But the dog did not like it. So he did not give 100% when I phoned him on Nov 16, 2012 (today). He said the dog is 95% Ok with hair growth back to the areas. Except for front paws licking occasionally.

This case illustrated the great difficulty of some owners to do the Z/D food allergy elimination trial. "The dog is OK in the past 4 weeks," I said. "This is due to the medication. The real test will be the next 4 months. If you don't try the ZD, the dry dog food allergy may return once the drugs wear off."

Skin diseases are costly to treat but many owners don't realise the importance of review 4 weekly or the use of Z/D or equivalent food trials. The vet may need to keep a record and call the owner but we seldom do as we don't even have time to sit down.



Oct 21, 2012
Case came to me.

1181. Urine collection from guinea pigs for the vet - blood in the urine

PROCEDURES FROM TOA PAYOH VETS
BLOOD IN THE URINE

URINE COLLECTION BY THE OWNER/VET

1. Put guinea pig in a clean plastic box without chemicals. Syringe him or her 10 ml of water slowly.
2. Tilt the box slightly so urine will flow away from the faecal pellets.
3. Use a sterile syringe to collect the urine and give it to the vet. At least 0.5 ml of the urine or up to 5 ml.




URINE ANALYSIS
Urine dipstick test for blood etc.
Urine analysis by the lab
Urine cultures


X-RAY
5. X-ray of the bladder by the vet advised
Urinary sediments - amorphous urates (acidic urine) or amorphous phosphates (alkaline urine). In this case, urine analysis detected amorphous phosphates ++, the pH was 9.0 and bacteria was present in the urine.


CLINICAL SIGNS TO CO-RELATE WITH LAB FINDINGS
Loss of appetite
Difficulty in urination
Blood in the urine - red urine due to plant pigments or blood due to infection/trauma or urinary tract
Drinks a lot or little

ADVICES
It is difficult to use diet to acidify the urine. I advised a course of antibitoics,  cutting down on too much wheat grass and hay and more water to drink as well as pesticide-free vegetables.Will need to follow up on another urine analysis.  As at Nov 19, 2012, no complaint of haematuria.

1180. Second operation of the hamster with the right fore paw tumour

This morning, the young man came at 9.44 am to get his hamster operated. I was surprised that the hamster's cheek pouches were bulging with food and he looked much more alive than yesterday (Tuesday Nov 13, 2012 - a public holiday, Deepavali)

The young man had brought the dehydrated and easily tired hamster for surgery. "I had told your mum to quickly bring the hamster to me when the lump regrows," I had sliced off the large tumour on Oct 3, 2012, sparing the hand. "The hamster can hold and grip food after the surgery," the young man said. "But only last week, this growth started and became very big." It was a reddish globe of 8 mm x 8 m. It made the hamster look as if he was wearing a boxing glove. He was much irritated by it as it was painful and inflamed.

I prescribed oral antibiotics and pred yesterday 

1181. Skin diseases in two adult Westies

Case 1.
"You are so rough," the lady admonished me as I flexed and extended, abducted and adducted  the Westie's left shoulder and other joints of the left fore limb. She expected gentle manipulation.
"If the joints are normal, a vigorous manipulation would not cause any pain," I replied. "See, only the dog was crying when I extended the left fore paw, but had no reaction on the shoulder, elbow joints. Gentle manipulation may not show any problems in the joints."

Today is Saturday Nov 10, 2012. I was at the Surgery at 8.45 am. Phone calls came in at 9 am for appointments for Dr Vanessa and one for Dr Daniel but both were not working today. I caught up with my admin work, checking on associate vets'  cases, data mining, reviewing past medical records and doing a thousand and one things.

Suddenly a lady brought in her 7-year-old male Westie saying the dog had been limping. The dog could put weight on the left fore limb but occasionally lifted it up quite high as I observed him in the waiting room. He wouldl not walk into the consultation room where the lady called. So I came out and opened the door. Slowly he went in.

"The dog's backside is itchy," the lady in her late 30s said. "I sent him to the groomer recently."
"The dog's anal area is black and brown," I expressed the anal sacs and blood with dark brown oil were seen on the tissue paper applied to

"Has your Westie any more infection of the ears and the skin?" I checked the medical records. The Westie was a referral from her friend who was 16 years old when I treated the case and was now 35 years old, according to this lady. So, 19 years had passed for this young girl whose identity I do not know.
Westies are famous for skin diseases and so I reviewed this case of success for my knowledge.   The owner did follow up reviews and the disease was cured

10.33 am Another client with a Pom comes in.

1178. Gum ulcer in the 15-year-old cat

Taught the owner how to "inject" feed pellets into the old cat. She had a gum ulcer and so did not eat. The owner did not know how to use the syringe or pill popper and so the pellets fall out from the mouth. 
Why did the old cat stop eating? Is it because she's 15 years old. At the end of the life span? Vet 1 had been consulted and gave some medication.

"My cat attempts to grip the food, but gave up."
So there would be some problems with the mouth. I opened the mouth. A big swollen lump appears at the gum/tooth junction of the left upper canine. This was extracted. The cat still would not eat. The owner had to syringe feed 3 to 4 times a day again.

I examined the case a few days later. There was an ulcer caused by the long sharp left lower canine, causing a red oval ulcer in the opposing upper area where the canine teeth had been extracted. The periodontal abscess of the left upper canine gum area had shrunk. This was good news.

left lower canine was extracted. A big tumour was seen growing on the spinal area. "This looked like a nasty fast-growing tumour. It is best to send to the lab for testing," I said. The big tumour was excised and the lab results showed a poor differentiated carcinoma.

Yet the cat would not eat and the owner had to go on a business trip. He said to me, "My cat does not have cancer as the test did not show cancer. Yet she is not eating. Do you have any medicine to make her eat?" I asked Dr Daniel if he had said that but he did not say that. A carcinoma of the skin is cancerous.

The cat still had that upper gum ulcer. But the main problem was that he did not use the syringe popper properly. He did not insert it far back to the back of the mouth. So the dry pellet just landed in front of the mouth and the cat just pushed it out. Dr Daniel and Min showed him how to do it. We put the cat on the table, one person opened the mouth and the other popped 5 dry food pellets into the mouth via the popper. The cat swallowed.

Nov 13, 2012 update. The owner said that the cat was eating a bit and was interested in food after Dr Daniel prescribed some tolfedine painkillers.

Later,

1177. Follow up on Ascites in the Pom

Today Friday Nov 9, 2012.

I reviewed the case handled by Dr Vanessa. She had aspirated some at 1 bdominal fluid yesterday and again today and the abdomen was not so tense. The dog ate a little.

"There appeared to be a large abdominnal tumour," I believed it could be a malignant metastasis from the breast tumours excised by Vet 1 earlier. In any case, the dog had a very high total white cell count, indicating a blood spreading bacterial infection. The dog was sent home with medication and given a poor prognosis.

"The tumour may be inoperable," I advised no surgery as the dog was in very poor health and would likely die on the operating table. No dog owner would forget the death as it would be emotional and costly. Therefore, I asked for the dog to be sent home today for observation. The cause of the ascites could be the heart disease.

Further X-rays and tests are needed but this would be too costly. The vet must understand the cost and the chances of survival before undertaking surgery. Inoperable tumours and poor health and heart disease are best not operated.   

In conclusion, I wonder whether it would have been kinder for the female dog if she had been spayed at a young age as breast tumours are less likely to develop during her senior years. Vet 1 did not send the tumours for histopathology based on economic reasons.