"A house call will not be useful as the cat needs a blood test," I said to the lady who phoned for a house call as the 16-year-old cat drank and peed a lot. "The blood test will show whether the cat has diabetes, liver or kidney disease. The heart needed to be checked too. I will recommend a pet transport man to bring the cat down to the Surgery. "
Evidence-based medicine is best practised. The cat was quite ferocious (does not like strangers) but Dr Daniel managed to give him isoflurane gas anaesthesia and collect blood from the jugular vein.
1. Triglycerides 50 (elevated) interferring with estimation of LDL cholesterol which can't be measured.
2. Glucose (Fasting) 25.5. Hyperglycaemia. (normal 3.9-6.0)
3. Urea <1 .8="" 154="" br="" but="" creatinine="" is="" nbsp="" normal="">low, creatinine normal. No kidney disease.
4. Eosinophils 18%, Absolute 1.22. Platelets 286 (300-800).
Conclusion. Diabetes mellitus
Friday, July 19, 2013
1034. Health screening of newly purchased Rottweiler
Post-purchase examination. Seldom does the vet ask the owner to do a blood test after a general examination. This should be advised as the puppy seller gives the owner 24 hours to "return" the puppy if it is medically unsound.
In this case of an 8-month-old male Rottweiler, the significant finding is the kidney function.
Urea 3 (4.3-6.3). Creatinine 51 (89-177). I advised the owner to speak to the Seller as to whether he wants to return the puppy. I what's app the report to him as 24 hours have passed but it is now 48 hours after purchase.
The red blood cells are slightly low. Platelets 560 (200-500) are high. Monocytes 9.9%, Absolute 1.58, Eosinophils 8.8%, Absolute 1.41. N 52% Aabsol 8.24. L 30% Absolute 4.77, Basophil 0.
Total WCC 16 (6-17).
The main worry is the kidney profile. Is there a congenital renal disease?
Parvo and heartworm tests were done and negative.
In this case of an 8-month-old male Rottweiler, the significant finding is the kidney function.
Urea 3 (4.3-6.3). Creatinine 51 (89-177). I advised the owner to speak to the Seller as to whether he wants to return the puppy. I what's app the report to him as 24 hours have passed but it is now 48 hours after purchase.
The red blood cells are slightly low. Platelets 560 (200-500) are high. Monocytes 9.9%, Absolute 1.58, Eosinophils 8.8%, Absolute 1.41. N 52% Aabsol 8.24. L 30% Absolute 4.77, Basophil 0.
Total WCC 16 (6-17).
The main worry is the kidney profile. Is there a congenital renal disease?
Parvo and heartworm tests were done and negative.
1033. The retiree's two old dogs
Clinical Research.
Case study of two dogs well cared for to old age by a retire. I saw them starting from 2009.
1. Orphan. Maltese X. Male, Born 2002
Sep 25, 09. Teeth scaling and extraction. Left testicular tumour first. Right testicular tumour and circum-anal tumour. Now 16 years old. Neutered & circum anal tumour excised
Aug 2, 10. Histology: Malignant tumour compatible with a seminoma
Apr 4, 13 Generalised ringworm both dogs. No follow up by owner. Buys Neoderm. Self-treatment.
2. Bam. Maltese X. Male. Born 2001
Oct 2, 2009. Dental and teeth extraction.
Jun 12, 2010. Left eye corneal ulcer. 3rd eyelid flap. Ear itchy. Ear cleaning & grooming. Nov 14,10
Aug 14, 2012. Blood test, ear irrigation, teeth
Apr 4, 13. Drinks and pees a lot. Blood test. Liver disorder.
Generalised ringworm both dogs. No follow up by owner owing to financial constraints.
Jul 17, 2013. Right eye corneal ulcer & >5mm across (image). Ears itchy.
Paw must have scratched eye causing ulceration. Owner thought the dog had conjunctivitis but the eye drops didn't work. E-collar advised. Conservative treatment.
CONCLUSION
"Generalised ringworm is a very difficult disease to eliminate," I said to the retiree. "Some dogs need 60 days of medication and daily anti-ringworm washing and decontamination of the environment and brushes. The owner needs to bring the dog for review 3-4-weekly instead of buying the Neoderm cream. A very itchy disease. Dog scratches ear and could have injured his right eye now, causing eye ulcer. Clipping the dog bald revealed the ringworm patches. The dog went home on conservative eye ointment + e-collar treatment instead of surgery, to save on medical costs.
Case study of two dogs well cared for to old age by a retire. I saw them starting from 2009.
1. Orphan. Maltese X. Male, Born 2002
Sep 25, 09. Teeth scaling and extraction. Left testicular tumour first. Right testicular tumour and circum-anal tumour. Now 16 years old. Neutered & circum anal tumour excised
Aug 2, 10. Histology: Malignant tumour compatible with a seminoma
Apr 4, 13 Generalised ringworm both dogs. No follow up by owner. Buys Neoderm. Self-treatment.
2. Bam. Maltese X. Male. Born 2001
Oct 2, 2009. Dental and teeth extraction.
Jun 12, 2010. Left eye corneal ulcer. 3rd eyelid flap. Ear itchy. Ear cleaning & grooming. Nov 14,10
Aug 14, 2012. Blood test, ear irrigation, teeth
Apr 4, 13. Drinks and pees a lot. Blood test. Liver disorder.
Generalised ringworm both dogs. No follow up by owner owing to financial constraints.
Jul 17, 2013. Right eye corneal ulcer & >5mm across (image). Ears itchy.
Paw must have scratched eye causing ulceration. Owner thought the dog had conjunctivitis but the eye drops didn't work. E-collar advised. Conservative treatment.
CONCLUSION
"Generalised ringworm is a very difficult disease to eliminate," I said to the retiree. "Some dogs need 60 days of medication and daily anti-ringworm washing and decontamination of the environment and brushes. The owner needs to bring the dog for review 3-4-weekly instead of buying the Neoderm cream. A very itchy disease. Dog scratches ear and could have injured his right eye now, causing eye ulcer. Clipping the dog bald revealed the ringworm patches. The dog went home on conservative eye ointment + e-collar treatment instead of surgery, to save on medical costs.
Thursday, July 18, 2013
1031. Surgery: Tail docking of Poodles, Jack Russells and Schnauzers
Although animal lovers condemn tail docking as cruel acts, it is much more painful for puppies when breeders strangulate the tail with tight rubber bands to "dock" the tails in a do-it-yourself way. So, I offer this tail-docking service for home breeders who want the puppies' tail docked.
"Each vet has his or her own way to dock a less-than-4-day-old puppy's tail," I said to Dr Daniel. "You observe my method which is a fast and efficient process taking less than 1 minute/puppy docked and then do your own way. So, for 6 puppies, the whole process is completed in less than 5 minutes." The Australian university professors will teach their methods or may not as Australia has an anti-tail-docking culture for all puppies.
I asked him to stand beside me rather than opposite me and asked another person to position the poodle puppy for tail docking. He has to view from the point of the view of the operating vet rather than seeing from the opposite side.
1. The assistant holds the puppy horizontally and firmly with his elbows resting on the op table. The puppy's head faces to the left of the operating vet.
2. A narrow blunt-edge scissors is placed on the extended tail such that the upper blade is placed further backwards by 5 mm dorsally as compared to the lower blade. The upper blade grips the skin and is rotated cranially to the same plane as the lower blade.
3. The tail is cut in the same vertical plane. This results in the dorsal skin edge being 5 mm longer than the lower skin incision edge.
4. In this way, there will be no bone protrusion which may happen if the tail is docked just in one vertical plane by the two upper and lower bladder of the scissors. The assistant needs to hold the puppy vertically to provide a good view.
5. The coccygeal bone may not be cut at its joint. So, I use the blunt ended scissor to undermine and cut the partial bone fragment away to reveal the shiny joint surface.
6. KMnO4 powder is pressed onto the bleeders. This is very effective when the puppy is less than 2 days old. There was no bleeding in the 6 poodles docked.
7. The owner is advised not to let the dam lick away the KMnO4 powder in the tail for 24 hours by ensuring the feeding is supervised.
The above technique is not suitable for dogs over 4 days old as there will be too much bleeding post-op. Stitching the amputated ends will need to be done.
"Each vet has his or her own way to dock a less-than-4-day-old puppy's tail," I said to Dr Daniel. "You observe my method which is a fast and efficient process taking less than 1 minute/puppy docked and then do your own way. So, for 6 puppies, the whole process is completed in less than 5 minutes." The Australian university professors will teach their methods or may not as Australia has an anti-tail-docking culture for all puppies.
I asked him to stand beside me rather than opposite me and asked another person to position the poodle puppy for tail docking. He has to view from the point of the view of the operating vet rather than seeing from the opposite side.
1. The assistant holds the puppy horizontally and firmly with his elbows resting on the op table. The puppy's head faces to the left of the operating vet.
2. A narrow blunt-edge scissors is placed on the extended tail such that the upper blade is placed further backwards by 5 mm dorsally as compared to the lower blade. The upper blade grips the skin and is rotated cranially to the same plane as the lower blade.
3. The tail is cut in the same vertical plane. This results in the dorsal skin edge being 5 mm longer than the lower skin incision edge.
4. In this way, there will be no bone protrusion which may happen if the tail is docked just in one vertical plane by the two upper and lower bladder of the scissors. The assistant needs to hold the puppy vertically to provide a good view.
5. The coccygeal bone may not be cut at its joint. So, I use the blunt ended scissor to undermine and cut the partial bone fragment away to reveal the shiny joint surface.
6. KMnO4 powder is pressed onto the bleeders. This is very effective when the puppy is less than 2 days old. There was no bleeding in the 6 poodles docked.
7. The owner is advised not to let the dam lick away the KMnO4 powder in the tail for 24 hours by ensuring the feeding is supervised.
The above technique is not suitable for dogs over 4 days old as there will be too much bleeding post-op. Stitching the amputated ends will need to be done.
Wednesday, July 17, 2013
1030. Blood in the rabbit's urine
1.5-year old rabbit, obese, female.
"The rabbit is greedy for treats and ate a lot daily," the sister said.
"She also ate a lot of pellets. For the past 1 week, she has frequent urination. The sister and her friend took the rabbit to Toa PayohVets for a check up as the rabbit had become lethargic. The owner was busy at work and the sister and her aunt were very worried.
"Collect her urine without any stools," I advised over the phone. "Wash and clean the pee tray first." This was the most practical way to collect urine. Urine must be analysed as part of the practice of evidence-based medicine rather than just giving antibioitcs.
URINE TEST on Jul 8, 2013
pH 9, SG 1.005, Protein 3+, Blood 4+, WBC 0, RBC 999, Bacteria 3+, Amorphous phosphate 3+.
What to do?
Dr Daniel had the scalded genital area washed. He prescribed medication and the owner came later to take the rabbit home. "No more treats," I said.
FOLLOW UP
It is important to follow up as many Singapore pet owners don't review the case. Perhaps it is due to lack of time or financial constraints.
On Jul 17, 2013, 9 days after treatment, I phoned the non-owner sister. Since she did not reply, I sms her: "Is the rabbit still passing blood in urine? Pl update. Dr Sing. Toa Payoh Vets."
Her reply: "The first 2 days of medication no blood. But past few days, the urine seems to have blood. Not sure whether it is orangey or blood. The medication does not seem to have finished yet though. Is the medication supposed to be finished? But I have tried feeding her fresh veg (water cress) which she quite enjoyed. She seems to be a bit more hyper now."
My reply: "Do you still feed treats n pellets? U need to reduce at least 50% of dry food n treats."
In summary, I advised feeding as much fresh vegetables as possible without causing diarrhoea and monitor amount of water drunk. X-rays for bladder stones if there is still blood in the urine.
There is not much the vet can help the rabbit but to educate the owner by following up. Often, vets have no time to follow up. It is just not practical to follow up every case. In this case, there may be bladder stones but will the owner want to pay for X-rays of the bladder? As in people, the over-consumption of certain food or treats can lead to ill health. I suspect the kidneys may be involved too.
Since X-rays were not consented, it is hard to tell whether there are bladder stones. Tablets to acidify the urine is being given as well as antibiotics.
"The rabbit is greedy for treats and ate a lot daily," the sister said.
"She also ate a lot of pellets. For the past 1 week, she has frequent urination. The sister and her friend took the rabbit to Toa PayohVets for a check up as the rabbit had become lethargic. The owner was busy at work and the sister and her aunt were very worried.
"Collect her urine without any stools," I advised over the phone. "Wash and clean the pee tray first." This was the most practical way to collect urine. Urine must be analysed as part of the practice of evidence-based medicine rather than just giving antibioitcs.
URINE TEST on Jul 8, 2013
pH 9, SG 1.005, Protein 3+, Blood 4+, WBC 0, RBC 999, Bacteria 3+, Amorphous phosphate 3+.
What to do?
Dr Daniel had the scalded genital area washed. He prescribed medication and the owner came later to take the rabbit home. "No more treats," I said.
FOLLOW UP
It is important to follow up as many Singapore pet owners don't review the case. Perhaps it is due to lack of time or financial constraints.
On Jul 17, 2013, 9 days after treatment, I phoned the non-owner sister. Since she did not reply, I sms her: "Is the rabbit still passing blood in urine? Pl update. Dr Sing. Toa Payoh Vets."
Her reply: "The first 2 days of medication no blood. But past few days, the urine seems to have blood. Not sure whether it is orangey or blood. The medication does not seem to have finished yet though. Is the medication supposed to be finished? But I have tried feeding her fresh veg (water cress) which she quite enjoyed. She seems to be a bit more hyper now."
My reply: "Do you still feed treats n pellets? U need to reduce at least 50% of dry food n treats."
In summary, I advised feeding as much fresh vegetables as possible without causing diarrhoea and monitor amount of water drunk. X-rays for bladder stones if there is still blood in the urine.
There is not much the vet can help the rabbit but to educate the owner by following up. Often, vets have no time to follow up. It is just not practical to follow up every case. In this case, there may be bladder stones but will the owner want to pay for X-rays of the bladder? As in people, the over-consumption of certain food or treats can lead to ill health. I suspect the kidneys may be involved too.
1029. FLUTD in a young male neutered cat
The 3-year-old male neutered cat pees blood in the urine for the past couple of days.
Urine test showed no crystals. No X-rays were done to lower medical costs for heartlanders. This may reveal bladder stones. Recurrence of haematuria will necessitate X-rays.
Follow up 5 days after bladder irrigation and antibiotics - no more blood in the urine. It seems more male cats who prefer dry food, as in this cat, tend to get an attack of haematuria compared to female cats.
As to the prevention, canned food is advised but this cat will not eat canned food. Much depends on the owner to re-train the cat to eat canned food.
Urine test showed no crystals. No X-rays were done to lower medical costs for heartlanders. This may reveal bladder stones. Recurrence of haematuria will necessitate X-rays.
Follow up 5 days after bladder irrigation and antibiotics - no more blood in the urine. It seems more male cats who prefer dry food, as in this cat, tend to get an attack of haematuria compared to female cats.
As to the prevention, canned food is advised but this cat will not eat canned food. Much depends on the owner to re-train the cat to eat canned food.
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