1357. Sarcoma in an older rabbit has recurred

On Tue, Apr 9, 2013 at 8:50 PM, A@yahoo.com> wrote:

Hi Dr Sing,

my rabbit XIAO, has who had recently been to your clinic for removal of her sarcoma near her left eye.

Today we again felt a small spherical lump around 0.3-0.5cm in diameter big in an area just a little higher up the previous area, this time its sitting quite near the eye (just a little above the eyelid). Do you think we should just bring her over this sun for you to take a look and discuss what is best for her?

Otherwise she is eating well and elated to be just reunited with her companion. Her stitches are still there, has not dissolved yet, but since the boy has no lower teeth, he can't do anything to it.

Regards,

A

 

 EMAIL REPLY FROM DR SING DATED APRIL 10, 2013

 

Best to get it removed when it is very small and operable. However, please note that the sarcoma is spreading via the skin and there will be more recurrences. 

1356. TRUST & AUDIT CASE. 2 years of itchiness in a 6-year old Shih Tzu

I vaccinated this male Shih Tzu in 2006. "For the last 2 years, my dog has been scratching," the lady manager in her late 40s said to me as she order 24 cans of Z/D diet for her dog today, April 8, 2013 as her dog would not eat the dry Z/D by itself. She had bought them in Feb 23, 2013 to consult Dr Jason Teo, to get a repeat of the anti-fungal tablet and shampoo which was prescribed earlier on Jan 7, 2013 by Dr Daniel Sing. "My dog is now so much better. Only some scales on her back," she pointed to her own spinal area."

I retrieved the medical records to review the case. We had not seen this dog since April 2009. The owner had done various treatments of the skin diseases by herself using pet shop shampoos and other means. With no success.

In the first visit since 2009, on Jan 7, 2013, Dr Daniel wrote 2-year itch/hair loss. Appetite good. Diet: dry/canned food (potato/lamb). The dog was clipped bald, washed thoroughly. His ears were irrigated, anal glands expressed and teeth scaling was done. It was a major overall of the dog. Medication and anti-fungal shampoos were given for the owner to continue treatment.

"His hairs are growing," she said today.
"That's good news," I replied. "Many owners do not have such good success in the Shih Tzu's skin disease cases!"

The owner came just to buy the Z/D diet and did not bring the dog for a review as she is a busy manager in charge of sales of office machines.  It would be ideal to review the real dog but it is hard to insist on it. Skin diseases in the Shih Tzu are hard to treat and this was deemed by the owner to be a successful outcome.

"I don't think this is just Z/D or simply ringworm infection," I said to the owner. "It may be both. You have to control the itchiness of the paws and the elbows. Do you give dog treats?"

"Yes, I do," she said.
"Strictly on Z/D for 3 months as this is a food trial. Not even a piece of cake, bread or treat. Allergies may return."

It is best to get the dog down for a review of skin disease rather than buying Z/D diets. In this case, my belief is that the dog is now much less stressed since his ears and anal sacs are no longer itchy and painful. Many dogs use their hind legs to scratch their flanks when their ears are itchy but many owners assume the cause is skin infections of the flanks. Other dogs keep licking their anal area, scooter and bite their tails due to anal sac impaction, infection and pain but many owners are not aware of this anal sacculitis condition. Resolving these two problems do help in "curing" the skin disease in many dogs, in my observations.

If a dog does not have otitiis externa and anal sacculitis, he can be much relaxed and happier instead of trying to alleviate his irtchiness by licking and licking. The immune system become stable and his skin condition improves. Early skin disease treatment and review are best for the dog.  

.

1355. Double degree in law and top scores

April 9, 2013

I was glad for the father whose daughter got a position in an international law firm, Clifford Chance. "Do you know about Clifford Chance? She was interviewed for over 60 minutes although 30 minutes was scheduled," he told me. "She was lucky."  

"Yes, I know about Clifford Chance," I said. "It is one of those top international law firms. I had read about it in the newspapers." In addition, I had rented an apartment for one of its lawyers some years ago when I was an active realtor.

"There is no such thing as being lucky to get a position in Clifford Chance," I said. "She worked hard. Double degrees and top grades. Big firms employ the best and they pay most for top academic performers." I was glad for him as I knew he had been struggling over the years to send her to an overseas education in law.

Nowadays the Singapore Government no longer publicises the top scholars in "A" and "O" levels so as not to put "pressure" on the other students and concerns of the parents. Still top grades get the graduate choice employers and that is a fact of life.

As for graduates with average grades and in an area with excess graduates, the bigger veterinary practices in Singapore now prefers vets with 1-2 years of experience. In later years, they will take only those with more years of experience. But vets who are top in their cohort should have no problem getting employment and being choosy. Life is going to be much more competitive for vet graduates as there are more than 50 practices opened now. Good for the pet owners.           

1354. Sunday's interesting cases. The yorkshire wakes up the owner at 3 am every morning

Two ladies in their 40s brought their Yorkshire Terrier to me as the dog would not eat again.
"There is milk from her breast," I showed the thick creamy white nipple discharge. "She has false pregnancy and the hormones affect her appetite."
"Are you sure it is not pus?" the lady asked.
"No, it is milk."
"But she is not pregnant."
"That is why the condition is called false pregnancy. You will observe that she will pick up and carry or protect a toy or piece of cloth for the past few days."
"Yes, yes," she said. "At 3 am for the past few days, she wanted me to wake up so that she could go out of the room to pick up the yellow toy crocodile. At one time, she would growl if I touch it. She would carry the croc upside down. Much earlier, she wolfed down the canned food she used to hate!"
"These are abnormal behaviour signs of false pregnancy," I replied.
The owner had brought along the toy croc and I took an image of it. The Yorkshire was not interested in it now and growled at me.

I advised spay later but the owner wanted a puppy from her.
"It is hard to find a sire," she said.
"I can introduce you to a breeder," I said. "You know that some dogs do die from giving birth or pregnancy, like people?"
She knew the risks and that Yorkshire requires Caesarean sections usually.

1353. Sunday's interesting case. A head-shaking guinea pig.

Sunday

The poodle owner who bought a poodle puppy from a person who used fake vaccination certificates (reported in Straits Times & Facebook recently and complaint to the AVA) referred a fair lady with long false eyelashes.

The lady had brought the recumbent guinea pig to Vet 1 as emergency. "Vet 1 had dug out a lot of black ear wax," she said. "She said it was ear infection. She advised an MRI scan as ear infections affect the brain."

"Ear infections can lead to brain infections," I said. "There is a tube which connects the ear to a part of the brain."

"The guinea pig is very ill, he has runny nose and breathes very fast," I said. "The chances of survival are not good even with treatment."

"How many %?" she asked.
"Around 10%," I said.
"How long he would live?"
"Less than a week," I replied. "He is not eating or drinking."
"Do you think the guinea pig has ear disease just because there is wax inside the ears?"
"Yes," I said.
"Based on what?"
"There is pain on palpation of the ears, esp. the left ear," I demonstrated that the guinea pig squealed a bit when that part was palpated. But most important, you said the guinea pig had been shaking his head for the past 3 months. It is not normal to shake heads. Dogs with ear infections shake their heads for long periods of time."
As for MRI scan, I doubt whether it is economical for guinea pig owners to get it done. There must be an MRI scan reading expert to interpret the scans and I doubt Singapore has such veterinary MRI scanning experts. The scan can be sent to overseas experts but which guinea pig owner will pay $1,000 or more for an MRI scan? 

She brought the guinea pig home without treatment as that was her sister's guinea pig.  

 

1352. Sunday April 7,2013's interesting case. A vet's heavy responsibility

Death of a beloved dog is very emotional for the owner. After 5 days of IV drip and twice daily visits from the owner with his other Jack Russell (wired-haired), the sick Jack Russell (smooth-haired) passed away on Sunday morning. This case was treated by Dr Daniel.

Blood test had revealed extremely high serum urea and creatinine and high total white cell count in this vomiting anorexic dog of around 5 years of age. The owner was aware of the poor prognosis and came to visit daily with his other Jack Russell to let the latter know that his friend is very ill. As I worked from 9 am to 8 pm most days during week days, I would see him. He would talk to the sick Jack Russell as a friend and his wire-haired Jack Russell would see that the sick patient, sometimes lying down, at other days sitting up but with not much response.

The dog vomited in the first 2 days of hospitalisation and was maintained alive on IV drips and antibiotics. He was breathing heavily on Saturday and passed away overnight. Dr Daniel does not start work till 12 noon, but this was his case. I am very strict on such cases. The attending vet must inform the owner of the death as that is his or her responsibility. No other vet should do it. Owners will feel better if the attending vet does it. It is plain common sense but I believe that younger vets who are off duty deem that it is their private time - the "work-life balance" so much advocated nowadays.

In matters of death of a sick dog, there is no such thing as "work-life balance." I told Dr Daniel to phone him to inform him about the death even though he was off-duty on this Sunday morning at 9 am. I texted to him the owner's phone number. He texted back to say the owner's handphone was switched off. He had texted messaged. I reviewed the case record. There was the owner's residence tel number. I texted him to phone this number and some family member responded. I told Dr Daniel he was to come to the Surgery immediately before the owner arrived.

Death of a sick pet requires a vet to be present when the owner arrives. This should be the correct way. This is a vet's heavy responsibility although he or she is not working. The owner was already emotionally upset that his younger Jack Russell had become seriously ill without "cause".

I had explained to him that blood test did show a bacterial infection and the bacteria could be from the grass when his Jack Russell was exercised. "The other Jack Russell is healthy," he had said to me. "It is like dengue fever in a family. Not every family member is infected although they may be bitten by mosquitoes." Singapore has a spike in dengue fever in the last 3 months of so. He accepted the explanation. He knew the poor prognosis as Dr Daniel had told him.

Yet in the end, it was very emotional for him. Much less than for a woman. He brought his wire-haired Jack Russell to see the dead companion. "Say goodbye to him one more time," he brought the Jack Russell to see the dog again. Dr Daniel was present when he came and spoke to him. Cremation arrangements were made.

I expressed my condolences to him as he left. He took my hands to shake and wished me well. It was a very sad sunshine Sunday morning for me. It was good that the owner was satisfied with the care given to his dog. There should be no delay in informing the owner of his pet's death, before he arrives to visit as much unhappiness arise if this is not done as death is a very highly emotional issue.  Some owners would be very angry saying "Why don't you inform me when the dog dies."

Abuse of health care workers in human medicine are on the increase in Singapore, according to a Straits Times report I read recently. Some vet practices have put on written notices saying that pet owners who abuse the frontline staff will not be accepted.             

In any case, it is a vet's heavy responsibility to inform the owner when his pet dies. He should not have this mindset that he should not be disturbed during his time off, to achieve the "work-life" balance. A beloved pet's life has passed away. The vet should be responsible to the very end of the sick dog's life. 

P.S. In another similar case of high total white cell count, the Jack Russell of a similar age developed high fever and had stiff legs and extended neck and panting. He was on intensive IV drip. He cried non-stop on Day 2 and I thought euthanasia would have been an option to stop his pain. I tried various sedatives and pain-killers in addition to the usual medication and IV drip. Yet he recovered on Day 3 (Blog: A miracle on Good Friday case study). He is much better now.    

1351. A panting high-fevered dam with 2 one-week-old extra-large pups

On April 6, 2013, at around 8 am,  I was surprised to receive a phone call regarding the poodle X I had performed Caesarean section one week ago, being unable to stand up and panting furiously. "She is having milk fever," I said over the phone. "Give her some milk and honey and bring her to the Surgery at 9 am.

The owners were there at 8.30 am. Last week when I rushed to the Surgery which took a 20-minute drive, the owners were slow in arriving. There were some indecisions as to whether they wanted to do the C-section and so my rushing down to perform the emergency C-section was in vain. This time, they were much earlier as the dam was in distress.

All 4 limbs extended. Neck extended. Tongue out. Panting non-stop. I got Nai to take the rectal temperature which was 41.9 deg C. It was extremely high and delays in seeking medical treatment mean death. I gave the IV drip (Hartmann) together with 1 ml of the Calcium. Within 5 minutes, the panting stopped and the temp was 39.6 deg C. The dog recovered.

"Not a single drop of milk for the puppies," I advised. "Otherwise, the same problem will recur. You need to buy milk powder for the puppies and bottle feed."

The dam recovered but there is the common problem of feeding and nursing the two very young puppies. No experience at all.

FOLLOW UP
MARCH 30, 2103 10AM
Casesarean section done by me. 2 extra-large pups. All went home on the same day.

MARCH 31, 2013 10.59 am
SMS from me
Is XXX ok? Pl tel me. Dr sing toa payoh vets

MARCH 31, 2013  11.38 AM
SMS from owner
Hi dr sing. XXX is fine. Nursing well.

APRIL 6, 2013  9 AM
The dam had milk fever. Treated and recovered well.


APRIL 6, 2013 SMS  5.09pm
SMS from owner
Hi Dr Sing, I am XXX's owner. You told us to bottle feed the puppies. But they are refusing to drink. Is there anything I can do about it?

PHONE
I phoned to advise using very warm milk, ensuring the teat has more than one hole and placing the pups near their mother. Less concentrated milk.

APRIL 6, 9.47 AM
SMS from me
Are puppies drinking bottled milk now?

10.31 pm
SMS from owner
No, they drank very little milk.

11.33 pm from me SMS
Give milk every 2 hours

APRIL 7, 2013  12 AM
SMS from owner
The puppy stool is watery. Is it normal?

5.30 am
SMS from me
Usually soft stools. New milk makes it watery


5.30 am
They hardly drink any milk. The tummy isn't round and full like it used to be.

Use syringe to feed warmed milk every 2 hours at least 20 ml till they are full. Or buy goat milk powder to give milk. You need to feed the amount (20 ml).


Very few people are successful in rearing 1-week-old pups. U need to read up on internet on how to do it.


SUNDAY APRIL 7, 2013
4pm
Phoned the owner. No response from her mobile.


APRIL 7, 2013  11.02pm
The owner texted to me.

Hi Dr Sing, Puppy is finally drinking milk. I went to make my own milk for them by Googling and I bougth human milk bottles instead of the dog pet shop bottles. The nipples for the bottles are much softer. Thanks for your help!


P.S
Most popular mobile apps
1. Instagram - enhances and posts digital photos online
2. Snapchat  - sends text or videos which self-destructs within 10 seconds of being opened. However anyone who captures the text or video within 10 seconds,  as a "screen shot" can save the image to the phone
3. Kit Messenger - unlimited texting for free & user's anonymity



4. KidzVuz.com  - tween video-review site, blog on technical and education issues