1360. Case-study: C-section & Eclampsia in a Poodle X

TOA PAYOH VETS toapayohvets.com Date:   12 April, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Caesarean section & eclampsia in a poodle X  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written:  11 April, 2013 Date:   12 April, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 On March 28, 2013, at around 8 am, a young lady phoned me to enquire about my fees for a Caesarean section for her dog. Her PoodleX dog that had not given birth to another pup since before 4 am. She discovered the first pup had been born naturally but it had died. "The fees would be $800," I quoted. "I live in Paya Lebar and will arrive in less than 20 minutes."   I ate my breakfast fast and drove fast the 20-minute drive to Toa Payoh Vets as this was an emergency C-section and time is of the essence. However the lady did not turn up till around 9.30 am. She was reading from her smart phone wrapped in a pink cover and putting the phone on her ears. She seemed to be speaking to somebody for a long time.  I knew there were some indecisions as to whether the C-section would proceed. "The dog had given birth naturally to one pup in her first litter," her mother said over the phone. "She had done it before. Why spend money on C-sections? Why not wait and see?" The young lady had waited and knew the consequences of procrastination. She cared for the life of her dam. Yet she was not the decision-maker.     "Is there an alternative to C-section?" this young lady of the internet generation that would do a lot of internet research about C-sections asked me. "Yes," I gave her a straight answer. "Your dog can be given an oxytocin injection to stimulate and contract her uterus. We could wait and see. But your dog has large pups, more than one as you can see from her much swollen belly. I would estimate 2 or 3 pups. They are large pups and the dam may not be able to push them out even if one pup could be born naturally.  In the end, the pups will die and decompose. You will still need a C-section to save the dam." This dog had uterine inertia but now was not the time to educate the owner about uterine inertia. I had other things to do as well. This was an emergency C-section and there was an objection by somebody in the family. C-sections cost money. Natural births are free of charge. I did not want to hard sell. This was the heartlander owner's decision. C-sections in dogs cost $1,000 - $2,000 as there was much work and time involved as you would see in this case study.  If the cost was $250, there might not be any objection from her mother. This C-section surgery itself took around one hour as there were complications with two pups not crying and breathing when they were taken out of the womb and had to be revived. It was 10 am before permission was given for the C-section. My intern Ms Toh had arrived for work and I asked her to video the process involved in an emergency C-Section and produce an educational video. Saturday, March 30, 2013 1346. Follow-up on the Caesarean section - young don't talk, she sms   For the past 2 days, I phoned the young lady but could not get through her mobile. Today Sunday, Mar 31, 2013,  I texted her: "Is CC OK? Pl tel me. Dr Sing. Toa Payoh Vets." She texted immediately: "Hi Dr sing. CC is fine. Nursing well." That is how the young Singaporeans communicate. Sure saves a lot of time. Below are the images of the Caesarean section from www.toapayohvets.com. An intern will produce a video later.     Saturday, April 6, 2013 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 Caesarean 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 CC'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 bought human milk bottles instead of the dog pet shop bottles. The nipples for the bottles are much softer. Thanks for your help!   1359. Follow up on Caesarean-section-milk-fever dam    I did a follow up on the lady by phoning her yesterday, April 11, 2013 and managed to get her on the phone. She said the extra-large pups are thriving on the "internet-researched" milk formula of yogurt-egg-yolk as in the link given by her below. The puppies were much larger than the sole pup naturally born in the first litter a few months ago. Also they drank 30-40 ml of this formula every 2-hourly, "not 20 ml" as suggested by me. I did not comment as the "20 ml"/2 hourly was a minimum for puppies at 7 days old. "What are the feeding times?" I asked. "Every 2 hourly except from 3 am to 7 am". Her mother helped her. Nowadays, the internet has much more information for pet owners and the younger generation can have more specialised knowledge on feeding orphan puppies than a veterinarian. The two puppies disliked the pet shop supplied milk powder and were losing weight. They also dislike the milk bottle nipple bought from the pet shop. But they loved the internet milk formula and human baby milk bottle. Vets can listen and learn much from the younger generation on some aspects of veterinary medicine as they focus on specific problem areas. Other home-breeders have successfully reared puppies using syringes and cow's milk or goat's milk. In all cases, they need to spend 2-hourly of feeding and know how to stimulate the puppy to pee and poop. Most vets in urban Singapore will not have many cases of C-sections in dogs unless they provide inexpensive loss-making $250 C-sections like I did some years ago and performed over 200 cases of C-sections from the professional dog breeders at Pasir Ris. Still vets need to know: 1. How to perform the Caesarean section competently 2. How to revive the distressed puppies (not crying or moving) when taken out during the C-section. 3. How to treat eclampsia 4. How to advise regarding "orphan" puppies. I will be producing a video on these aspects to educate vet student and pet owners.   On Wed, Apr 10, 2013 at 7:35 PM, J@gmail.com> wrote: Hi Dr Sing,   CC's owner here. We went over to your clinic 2 weeks back for the C-sect. Here's the link to the puppy formula. http://leerburg.com/bottlefeeding.htm They did mention that using a human milk bottle is better than the pet dog milk bottle so I actually bought the human milk bottle. The nipples are much softer than the dogs milk bottle.   Thank you! We will come back for the vaccination in 1 1/2 weeks time.   ------------------------------------------------------------------------- EMAIL REPLY FROM DR SING DATED April 11, 2013 Thank you for sharing info on how you successfully feed the 7-day-old puppies since their mother has eclampsia (milk fever). Eclampsia usually occurs in the first litter for small breeds but your dog had given birth naturally once earlier. The present milk congested mammary glands will reduce in size with time. She had no milk produced when I saw her for the treatment of milk fever 7 days after her Caesarean section and this could be due to the fact that the two pups had drunk all the milk. In retrospect, the two extra-large pups could have been given alternative milk (e.g. goat's milk formula or the one in your email link) for some periods of time, giving the dam time to recover and produce milk.    The two extra-large puppies would have died if you have not researched the internet. Now they have put on weight and do not have watery stools as they dislike the pet shop supplied milk powder and bottle. First vaccination for your two pups will be at 8 weeks of age since they don't live in an environment with lots of viruses as in a professional dog breeder's farm.   Best wishes. Update will be on this webpage: http://www.bekindtopets.com/dogs/20130411eclampsia_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: April 12, 2013 Toa Payoh Vets

1359. Follow up on Caesarean-section-milk-fever dam

toapayohvets.com Date:   11 April, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Caesarean section & eclampsia in a poodle X  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   11 April, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1359. Follow up on Caesarean-section-milk-fever dam    I did a follow up on the lady by phoning her yesterday, April 11, 2013 and managed to get her on the phone. She said the extra-large pups are thriving on the "internet-researched" milk formula of yogurt-egg-yolk as in the link given by her below. The puppies were much larger than the sole pup naturally born in the first litter a few months ago. Also they drank 30-40 ml of this formula every 2-hourly, "not 20 ml" as suggested by me. I did not comment as the "20 ml"/2 hourly was a minimum for puppies at 7 days old. "What are the feeding times?" I asked. "Every 2 hourly except from 3 am to 7 am". Her mother helped her. Nowadays, the internet has much more information for pet owners and the younger generation can have more specialised knowledge on feeding orphan puppies than a veterinarian. The two puppies disliked the pet shop supplied milk powder and were losing weight. They also dislike the milk bottle nipple bought from the pet shop. But they loved the internet milk formula and human baby milk bottle. Vets can listen and learn much from the younger generation on some aspects of veterinary medicine as they focus on specific problem areas. Other home-breeders have successfully reared puppies using syringes and cow's milk or goat's milk. In all cases, they need to spend 2-hourly of feeding and know how to stimulate the puppy to pee and poop. Most vets will not have many cases of C-sections in dogs unless they provide inexpensive loss-making $300 C-sections like I did some years ago and performed over 200 cases of C-sections from the professional dog breeders at Pasir Ris. Still vets need to know: 1. How to perform the Caesarean section competently 2. How to revive the distressed puppies (not crying or moving) when taken out during the C-section. 3. How to treat eclampsia 4. How to advise regarding "orphan" puppies. I will be producing a video on these aspects to educate vet student. On Wed, Apr 10, 2013 at 7:35 PM, J@gmail.com> wrote: Hi Dr Sing,     XXX's owner here. We went over to your clinic 2 weeks back for the C-sect.   Here's the link to the puppy formula. http://leerburg.com/bottlefeeding.htm   They did mention that using a human milk bottle is better than the pet dog milk bottle so I actually bought the human milk bottle. The nipples are much softer than the dogs milk bottle.   Thank you! We will come back for the vacination in 1 1/2 weeks time.   -------------------------------------------------------------------------------- EMAIL REPLY FROM DR SING DATED April 11, 2013 Thank you for sharing info on how you successfully feed the 7-day-old puppies since their mother has eclampsia (milk fever). Eclampsia usually occurs in the first litter for small breeds but your dog had given birth naturally once earlier. The present milk congested mammary glands will reduce in size with time. She had no milk produced when I saw her for the treatment of milk fever 7 days after her Caesarean section and this could be due to the fact that the two pups had drunk all the milk. In retrospect, the two extra-large pups could have been given alternative milk (e.g. goat's milk formula or the one in your email link) for some periods of time, giving the dam time to recover and produce milk.    The two extra-large puppies would have died if you have not researched the internet. Now they have put on weight and do not have watery stools as they dislike the pet shop supplied milk powder and bottle. First vaccination for your two pups will be at 8 weeks of age since they don't live in an environment with lots of viruses as in a professional dog breeder's farm.   Best wishes. JH ------------------ Other related articles 1.  http://2010vets.blogspot.sg/2013/04/1351-panting-high-fevered-dam-with-2.html 2. http://2010vets.blogspot.sg/2013/03/1346-follow-up-on-caesarean-section.html   Update will be on this webpage: www.bekindtopets.com/dogs/20130411eclampsia_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: April 11, 2013 Toa Payoh Vets

1358. AUDIT & TRUST CASE. The 5-year-old Shih Tzu scratches and bites paws

April 9, 2013

As Shih Tzus are quite popular in Singapore, I get more of such patients. Today, a couple in their 40s and residing in Simei brought in the Shih Tzu at 8 pm. Sometimes I closed at 8 pm sharp or 10 minutes earlier as most clients would phone for appointments.

I had returned to the clinic at 7.30 pm to help out Dr Daniel if necessary. In addition, a man who drives a Lexus SUV and in his late 50s had phoned to say he would bring in 3 more stray cats for neutering and sometimes he would be late and Dr Daniel would have closed the clinic. He came around 7.55 pm and I told Dr Daniel to attend to him as there was a relationship of trust and he had done his previous stray cats which would be sterilised, left ear clipped and released back to the community. 

After this man, the couple from Simei turned up at 8 pm. They lived quite far away, in North-eastern Singapore and they had to rush here after work. There are other vet practices nearer to their home nowadays but skin diseases that have successful clinical outcomes after treatment get repeat visits from the owner.

This female spayed Shih Tzu was seen by me as a puppy in 2008 for vaccination and I spayed her as a one-year-old in 2009. Now she had all four paws itchy and infected, a circular bleeding patch of hair loss on top of her head and an area of skin infections above her neck. "I think oral ringworm tablets are needed," the wife said to me. "None was given in the past two treatments."

"Let me review the medical records and check for ringworm," I said. I noted that her dog had been treated by my associate vet first in September 17, 2012 for demodecosis. The skin scraping was positive for demodex mites.  The dog was clipped bald. Anti-mite injections were given on Sep 22 and 30, 2012 and on Oct 7, 2012. In Dec 30, 2012, Dr Daniel treated the skin disease for demodecois as her paws were red and swollen, the backside and below the neck skin were inflamed. In Jan 6 and 22, 2013, the owner came for anti-mite injection and now news from her till today, April 9, 2013.

Superficially, this would again be a recurrence of demodecosis and the usual injections would be given. The owner had requested for oral anti-fungal tablets as she must have done her internet research.
 The owner had stated unequivocally that the scratching of her head and chewing of her paws commenced only two weeks ago. The owner had done her own clipping of the coat and the dog wore an e-collar at all times and the whole body was no longer itchy.

"Did you change to a new brand of dog food?" I assessed there was a period of little or no skin inflammation from Jan 22, 2013 for the past 2 months.

This was a very important piece of clue. Some factors had caused a new occurrence of skin disease.

"Yes," she said. "I used to feed wet food but change to Alpo dry food 2 weeks ago. My old maid had gone back home and I have a new maid. My dog would not eat and so I bought trhe Alpo dry dog food for the new maid to feed her."

"Your dog is a one-man dog and missed the previous maid badly," I should have said a 'one-woman' dog.
So there was a possible cause of dry food allergy. It seemed to be obvious in this case. The dog would be on wet canned food for the next 3 months after treatment of the skin infections.

As to the oral anti-fungal medication requested by the owner, I showed the medical record that Dr Daniel had prescribed anti-fungal tablets for 15 days on December 31, 2012. During the review in Jan 6 and 22, 2013 by him when anti-mite injection was given, there was a slow improvement stated in the records but no anti-fungal medication was prescribed.

In retrospective analysis, would the fungal infection be still present in addition to demodecosis and skin infections?  Was this a pure case of dry dog food allergy as it seemed to be.

I warded the dog for clipping and full examination for the next day. The couple would come at around 8 pm to collect the dog. This case is a typical case of skin disease in the Shih Tzu. There were follow ups and there seemed to be a resolution in February. Till the dog was given dry dog food and started itching 2 weeks ago. Demodecosis could have returned as the immune system became suppressed. I need to review the whole dog thoroughly again. 

 

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.  

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