Since adoption in Nov 2011, this Scottish Terrier of 2 years 4 months, male dog had been farting almost daily. I reviewed his case records as he had been to see us for 7 times. The first time was Nov 2011 when he had vomited. In April 2012 he vomited and in Feb 2013 I was the vet attending to his vomiting again. This dog was described as a "habitual scavenger" by my associate. He would eat any food, eat the wooden stair case, lick any floor, drink his own urine and ate his own stools when he was young.
"I call him the 'lau hong' dog", the gentleman owner laughed when I spoke to him by phone on Feb 18, 2013, two days after treatment for vomiting 3 times and telling him that the dog's intestines were full of gas. A state of flatulence which had existed for over 2 weeks, he had said on Feb 16, 2013.
"Does he pass smelly gas?" I asked.
"I don't know as I don't smell it specifically."
"The smell of the gas will let us know what sort of bacteria and damage to the intestines occur," I explained.
"Sometimes, it is smelly. He keeps farting daily."
To the owner, this behaviour is normal. It is actually not normal. He consented to a blood test as he did not want one earlier nor an X-ray. Economics play a big role in heartlander practice.
Blood test revealed a lower than normal white cell count 5.2 (normal 6-17). Elevated PCV at 0.64 would give rise o an increase in RBC 9.4 (5.5-8.5) and haemoglobin 22 (12-18). The liver enzymes SGPT/ALT 119 (<59 0.19="" 10.7="" 472="" acid="" and="" br="" creatinine="" high="" normal.="" sgot="" so="" urea="" uric="" was="" were="">
What do the blood test tell me?
One blood test may not be reliable. It seems there is liver disorder and reduced white cell count. Was there a virus? The dog did not have his yearly vaccination.
What caused so much gas production in the intestines?
Tuesday, February 19, 2013
1297. Resection of a cancerous tumour in a Syrian hamster
On Valentine's Day, Dr Daniel and I operated to remove a huge blackened skin lump of 1.3 x 1.3 x 0.5 cm from the left shoulder of the 2-year-old Syrian hamster.
The ideal way in dogs would be to resect the skin of 1 cm away from the edge of the skin tumour according to the vet book to cut off any spreading cancer cells.
A Syrian hamster's shoulder area is so small. This is not practical as the wound would be so big that the stitching of the wound will not be possible.
In this hamster, the tumour was cut off. The owner did not want it to be sent to the lab for histology. It looked much like a cancerous tumour. Toa Payoh Vets would send it for confirmation.
Test showed it was malignant.
Hamster skin growths need to be removed by the vet when they are small as there is the danger of spreading and insufficient skin to cut off and to stitch up after resection.
Also anaesthesia by gas to top up as the surgery and stitching took some time. How much of gas to give by mask? This is a judgment of the vet.
"Insufficient," Dr Daniel said as he stitched up the wound after I took off the mask after giving a few seconds of 5% isoflurane and the hamster moved a bit.
"Every vet can operate on any size of large skin tumours in the hamster," I told him. "The only difference is which vet can operate such that the hamster survives at the end of the operation." 5% isoflurane is very potent to a hamster. 2 or 3 seconds of smell will do to top up Zoletil sedation which was need in this type of large tumour removal surgery. The hamster had 5 drops Zoletil 50 IM but was still not fully sedated. Hence the isoflurane gas top up. This is where the judgment of the vet comes in. A second more may just kill the hamster unlike that in the dog.
Hence there is a layman's belief that hamsters die on the operating table easily and many vets prefer not to operate but give medication for tumour cases. Medication never works. Anaesthesia may kill. So, many hamster owners wait and wait till there is no choice but to operate. By that time, as in this case, the tumour is massive and not all cancerous cells can be taken out.
I warn the owner that the tumour may recur again as it was not possible to make a big cut and to have sufficient skin to stitch up. The lab report indicated the resection margin had tumour cells and so I expected the tumour to recur.
The ideal way in dogs would be to resect the skin of 1 cm away from the edge of the skin tumour according to the vet book to cut off any spreading cancer cells.
A Syrian hamster's shoulder area is so small. This is not practical as the wound would be so big that the stitching of the wound will not be possible.
In this hamster, the tumour was cut off. The owner did not want it to be sent to the lab for histology. It looked much like a cancerous tumour. Toa Payoh Vets would send it for confirmation.
Test showed it was malignant.
Hamster skin growths need to be removed by the vet when they are small as there is the danger of spreading and insufficient skin to cut off and to stitch up after resection.
Also anaesthesia by gas to top up as the surgery and stitching took some time. How much of gas to give by mask? This is a judgment of the vet.
"Insufficient," Dr Daniel said as he stitched up the wound after I took off the mask after giving a few seconds of 5% isoflurane and the hamster moved a bit.
"Every vet can operate on any size of large skin tumours in the hamster," I told him. "The only difference is which vet can operate such that the hamster survives at the end of the operation." 5% isoflurane is very potent to a hamster. 2 or 3 seconds of smell will do to top up Zoletil sedation which was need in this type of large tumour removal surgery. The hamster had 5 drops Zoletil 50 IM but was still not fully sedated. Hence the isoflurane gas top up. This is where the judgment of the vet comes in. A second more may just kill the hamster unlike that in the dog.
Hence there is a layman's belief that hamsters die on the operating table easily and many vets prefer not to operate but give medication for tumour cases. Medication never works. Anaesthesia may kill. So, many hamster owners wait and wait till there is no choice but to operate. By that time, as in this case, the tumour is massive and not all cancerous cells can be taken out.
I warn the owner that the tumour may recur again as it was not possible to make a big cut and to have sufficient skin to stitch up. The lab report indicated the resection margin had tumour cells and so I expected the tumour to recur.
1296. Blank CD of digital X-ray
Yesterday, Feb 18, 2013 I brought a Jack Russell to a clinic for X-ray. The owner brought the dog in saying to Dr Daniel and I: "I heard a crutch....crutch...crutch...sound and this dog was under my car. If his injuries are too severe, put him to sleep."
"The dog must have slept under the car," I said.
"My SUV car has a high floor and he could be running under the wheels."
The dog was standing but limping on the right hind limb. Dr Daniel put the dog his left side on the examination table and gently palpated the right foot and lower limb. There was no pain reaction. I was beside him and so I flexed the right hip. The dog yelped. So there was intense pain and some swelling in the hip area.
Dr Daniel said: "There are muscle tremors in the right hip area" meaning that the car trauma would be in that area rather than the foot.
Was there a hip fracture? However, the dog looked
I had known this gentleman for over 20 years and though he can well afford any veterinary expenses, I know sometimes he will not want to pay and so I said: "If you want to want to save money, wait till tomorrow while we give the pain-killers." He was undecided. If the dog has a serious injury, then he would euthanase her.
So Dr Daniel decided on 3 X-rays - the abdomen one view and the hips 2 views. The storm clouds were gathering this afternoon. But I took the dog inside the crate to this clinic for the X-rays. The male vet was busy talking to a client and I said hello to him. Another vet attended to another client who wanted to borrow the "wheel chair" for his paralysed lame dog. The principal vet was busy consulting with clients. It seemed to be a bustling clinic in this stormy afternoon with a government department warning of flash floods.
So, I did not bother them. After the X-ray, I waited a while for the drizzle to stop and read a Pets' Magazine. A slim frontline girl in light yellow uniform asked me whether I wanted an umbrella. I said yes and she gave me one. I took the dog out. Another staff (a volunteer) in greyish blue uniform was behind me and helped to open my car door so I could put the dog crate in. Service from the front-line staff was excellent in this clinic. As there was a "We reserve the right not to serve you" notice on the lower front of the receptionist table, I did not make any conversation with the staff. In case of misunderstanding? Actually they were too busy to make idle conversation too. Once I got into the car, the storm clouds burst.
On returning to Toa Payoh Vets, Intern Ms Toh came out to take the crate and the CD of the X-ray. "This CD is blank," Dr Daniel said to me. I was much amazed as this had not happened before. How did it happen? I don't know. Dr Daniel phoned the clinic to ask for the email copy. I answered the phone when the clinic called. The staff manning the phone said: "You will have to wait a while for us to email to Dr Daniel. The vets are busy."
Cock ups do happen in the service industry. It is one of those surprises in life. This must be a rare occurrence.
"The dog must have slept under the car," I said.
"My SUV car has a high floor and he could be running under the wheels."
The dog was standing but limping on the right hind limb. Dr Daniel put the dog his left side on the examination table and gently palpated the right foot and lower limb. There was no pain reaction. I was beside him and so I flexed the right hip. The dog yelped. So there was intense pain and some swelling in the hip area.
Dr Daniel said: "There are muscle tremors in the right hip area" meaning that the car trauma would be in that area rather than the foot.
Was there a hip fracture? However, the dog looked
I had known this gentleman for over 20 years and though he can well afford any veterinary expenses, I know sometimes he will not want to pay and so I said: "If you want to want to save money, wait till tomorrow while we give the pain-killers." He was undecided. If the dog has a serious injury, then he would euthanase her.
So Dr Daniel decided on 3 X-rays - the abdomen one view and the hips 2 views. The storm clouds were gathering this afternoon. But I took the dog inside the crate to this clinic for the X-rays. The male vet was busy talking to a client and I said hello to him. Another vet attended to another client who wanted to borrow the "wheel chair" for his paralysed lame dog. The principal vet was busy consulting with clients. It seemed to be a bustling clinic in this stormy afternoon with a government department warning of flash floods.
So, I did not bother them. After the X-ray, I waited a while for the drizzle to stop and read a Pets' Magazine. A slim frontline girl in light yellow uniform asked me whether I wanted an umbrella. I said yes and she gave me one. I took the dog out. Another staff (a volunteer) in greyish blue uniform was behind me and helped to open my car door so I could put the dog crate in. Service from the front-line staff was excellent in this clinic. As there was a "We reserve the right not to serve you" notice on the lower front of the receptionist table, I did not make any conversation with the staff. In case of misunderstanding? Actually they were too busy to make idle conversation too. Once I got into the car, the storm clouds burst.
On returning to Toa Payoh Vets, Intern Ms Toh came out to take the crate and the CD of the X-ray. "This CD is blank," Dr Daniel said to me. I was much amazed as this had not happened before. How did it happen? I don't know. Dr Daniel phoned the clinic to ask for the email copy. I answered the phone when the clinic called. The staff manning the phone said: "You will have to wait a while for us to email to Dr Daniel. The vets are busy."
Cock ups do happen in the service industry. It is one of those surprises in life. This must be a rare occurrence.
Monday, February 18, 2013
1295. Porto-systemic shunt in a young dog?
Feb 18, 2013
I note that many young vets who have grown up in an era of abundance don't have much spare time for more detailed research as they have their own hobbies and friends who want to go on vacations and spend late nights networking. The start up of their new clinics are paid for by benefactors and not from their sweat and tears.
However, research needs to be done if they want to excel in their profession and gain a solid reputation for being good at diagnosis and treatment. There is no short cut to veerinary excellence and the necessary sacrifices of hours must be spent in doing reading and reviewing challenging cases.
One example of a challenging cases I encountered was this very thin Maltese puppy who barked a lot, mostly at night and liked to lick objects and things. "He barks mostly at night because we don't permit him to enter our bedroom," the young lady side of a couple said to me. "My dad has to work overnight shifts and gets disturbed."
"Why don't you cage him at night and put him in the kitchen?" I said.
"He still barks."
So there was no solution.
"He has another problem. He will like all foreign objects and things and would vomit hairs! Can we muzzle him the whole day long?"
"Dogs need to breathe through panting and muzzling for a long time may kill them," I said. So there was no solution.
"He also urine marks all over the apartment," the lady said.
"Neuter him early," I said. "It will reduce his dominant personality. You will note that he is a dominant male and has no respect for female family members."
"You are quite correct," the young man confirmed. "He only listens to me if I am around."
"This dog is very thin, as if he has not been fed much," I said. "Or is there something wrong with his health? I advise a health screening blood test to check the liver and kidney functions as well as the blood system."
A blood test was agreed. The results show liver disorders in that ALT/SGPT = 294 (normal <59 0.02="" 262="" 6.8="" acid="" and="" ast="" at="" high="" nbsp="" normal="" slightly="" urea="" uric="" was="">and creatinine was low at 82 (normal 89-177).
Haemoglobin was high at 19.6 (normal = 12-18).
The main disorder was the high liver enzymes. Uric acid is normal. Serum urea is slightly high. Is there an early onset of a porto-systemic shunt or not? Congential liver disease? Liver damage due to licking of floors and objects getting poisoned?
I phoned the owner for a urine test to check for urate crystalluria. Due to economics, I did not ask earlier. Will need to follow up on this case.
I note that many young vets who have grown up in an era of abundance don't have much spare time for more detailed research as they have their own hobbies and friends who want to go on vacations and spend late nights networking. The start up of their new clinics are paid for by benefactors and not from their sweat and tears.
However, research needs to be done if they want to excel in their profession and gain a solid reputation for being good at diagnosis and treatment. There is no short cut to veerinary excellence and the necessary sacrifices of hours must be spent in doing reading and reviewing challenging cases.
One example of a challenging cases I encountered was this very thin Maltese puppy who barked a lot, mostly at night and liked to lick objects and things. "He barks mostly at night because we don't permit him to enter our bedroom," the young lady side of a couple said to me. "My dad has to work overnight shifts and gets disturbed."
"Why don't you cage him at night and put him in the kitchen?" I said.
"He still barks."
So there was no solution.
"He has another problem. He will like all foreign objects and things and would vomit hairs! Can we muzzle him the whole day long?"
"Dogs need to breathe through panting and muzzling for a long time may kill them," I said. So there was no solution.
"He also urine marks all over the apartment," the lady said.
"Neuter him early," I said. "It will reduce his dominant personality. You will note that he is a dominant male and has no respect for female family members."
"You are quite correct," the young man confirmed. "He only listens to me if I am around."
"This dog is very thin, as if he has not been fed much," I said. "Or is there something wrong with his health? I advise a health screening blood test to check the liver and kidney functions as well as the blood system."
A blood test was agreed. The results show liver disorders in that ALT/SGPT = 294 (normal <59 0.02="" 262="" 6.8="" acid="" and="" ast="" at="" high="" nbsp="" normal="" slightly="" urea="" uric="" was="">and creatinine was low at 82 (normal 89-177).
Haemoglobin was high at 19.6 (normal = 12-18).
The main disorder was the high liver enzymes. Uric acid is normal. Serum urea is slightly high. Is there an early onset of a porto-systemic shunt or not? Congential liver disease? Liver damage due to licking of floors and objects getting poisoned?
I phoned the owner for a urine test to check for urate crystalluria. Due to economics, I did not ask earlier. Will need to follow up on this case.
Skin disease can be due to multiple causes
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TOA
PAYOH VETS
Sunday, February 17, 2013
Squamous cell carcinoma in a dog
1. Hook
Video - 3rd day of surgery - going home. Dog looks forward to going home.
What happened?
Be Kind To Pets info
2. Introduction
Image of amputated dog. Seen 2 vets. Vet 1 diagnosed cancer. Went to Vet 2 who X-rayed the lower leg skin tumour
Insert X-Ray
and took skin biopsy to send to the lab for analysis. Lab confirmed squamous cell carcinoma of the skin.
Insert "Squamous cell carcinoma"
However Vet 2's operating theatre facilities not functional, so phoned me and surgery was done on Feb 15, 2013
3. Middle
Treatment - Amputation
- Chemotherapy not advised as it is not beneficial to the dog
4. Conclusion
4.1. What is the survival time? the owner asked.
Depends on: spread or not. If not spread, good chances of not recurring.
4.2 Nursing at home. Pain killers, antibiotics and confinement to a crate for 14 days
Video dog going home.
5. Tips & Advices
5.1 Small skin growths in the older dog especially should be removed by your vet early.
5.2 Small skin growths that do NOT heal at all may be cancerous.
5.3 Black pigmented skin growths may be squamous cell carcinomas. Cancerous. Best to get them removed when they are small.
6. Be Kind To Pets & credits
Video - 3rd day of surgery - going home. Dog looks forward to going home.
What happened?
Be Kind To Pets info
2. Introduction
Image of amputated dog. Seen 2 vets. Vet 1 diagnosed cancer. Went to Vet 2 who X-rayed the lower leg skin tumour
Insert X-Ray
and took skin biopsy to send to the lab for analysis. Lab confirmed squamous cell carcinoma of the skin.
Insert "Squamous cell carcinoma"
However Vet 2's operating theatre facilities not functional, so phoned me and surgery was done on Feb 15, 2013
3. Middle
Treatment - Amputation
- Chemotherapy not advised as it is not beneficial to the dog
4. Conclusion
4.1. What is the survival time? the owner asked.
Depends on: spread or not. If not spread, good chances of not recurring.
4.2 Nursing at home. Pain killers, antibiotics and confinement to a crate for 14 days
Video dog going home.
5. Tips & Advices
5.1 Small skin growths in the older dog especially should be removed by your vet early.
5.2 Small skin growths that do NOT heal at all may be cancerous.
5.3 Black pigmented skin growths may be squamous cell carcinomas. Cancerous. Best to get them removed when they are small.
6. Be Kind To Pets & credits
1292. Toilet training an older poodle again
On Wed, Feb 13, 2013 at 1:20 PM, f@yahoo.com.sg> wrote:
Hi, I need your advice.I have a toy poodle, she is spayed and can pee on tray 100%. But when she was 3 years old, I brought home a mini poodle puppy.Since then she refuse to pee on the same tray. I put another tray in another room, she pee on the new tray some times. And rest of the times, she pee on the floor around the tray that the new dog pee.I cant grab her to put her on the tray as she is very aggressive, and growl and bite.I have tried to give her more attention, and also tried to beat her, but she just get worseWhat should I do?Thanks first
EMAIL REPLY FROM DR SING DATED FEB 17, 2013
Hi
Thank you for your email. It is not easy to give advice in your situation of two poodles competing for your attention. Have you tried "positive reinforcement" method of treats and praises for performance? Or the clicker method?
1. Spend time with the old poodle.
2. When she pees on the tray, give her treats and/or praises or bring her for exerciseThis depends which motivates her.
3. Use the old tray which has her urine smell. What happened to it?
4. Neutralise the urine smell on the floor.
5. Confine to small area again as in puppy toilet training.
6. Spay her if relevant.
7. Many weeks and months of positive reinforcement training may be needed to change the behaviour as the dog is an adult and not a puppy with ease of training.
8. Ensure she has no urinary tract infection - check with your vet. Urine test.
9. There may be a need to separate both poodles for some time and to wash your hands when you handle the younger poodle before handling the older one.
10. Pee trays may NEED to be washed frequently if your old poodle is a cleanliness freak and this may be one reason she will not pee on the pee pan but outside the perimeter..
11. Use the commercial pee pads to absorb the urine as a different approach and trial?
The above are some of my suggestions and I don't know whether they will work. Best wishes.
Thank you for your email. It is not easy to give advice in your situation of two poodles competing for your attention. Have you tried "positive reinforcement" method of treats and praises for performance? Or the clicker method?
1. Spend time with the old poodle.
2. When she pees on the tray, give her treats and/or praises or bring her for exerciseThis depends which motivates her.
3. Use the old tray which has her urine smell. What happened to it?
4. Neutralise the urine smell on the floor.
5. Confine to small area again as in puppy toilet training.
6. Spay her if relevant.
7. Many weeks and months of positive reinforcement training may be needed to change the behaviour as the dog is an adult and not a puppy with ease of training.
8. Ensure she has no urinary tract infection - check with your vet. Urine test.
9. There may be a need to separate both poodles for some time and to wash your hands when you handle the younger poodle before handling the older one.
10. Pee trays may NEED to be washed frequently if your old poodle is a cleanliness freak and this may be one reason she will not pee on the pee pan but outside the perimeter..
11. Use the commercial pee pads to absorb the urine as a different approach and trial?
The above are some of my suggestions and I don't know whether they will work. Best wishes.
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