Tuesday, February 25, 2014
Monday, February 24, 2014
1341. Exploratory laparotomy in an old dwarf hamster - recto-vaginal fistula - a rare case
Sunday Feb 23, 2014's interesting case.
TP 44844
Dwarf hamster, F, 2.5 years, 39 g
"My dwarf hamster passed blood in the stools for the last 2 days," the gentleman said.
"Did she pass the normal stool pellets?" I asked.
"None at all in the last 2-3 days. Maybe, a small pellet recently."
"Any urine passed?" I asked as this hamster had a swollen abdomen as if she was pregnant.
"I was overseas for the last 2 weeks and my family members fed her chym sim instead of the normal hamster pellets and seeds."
Blood appeared in the vulval area but the owner said the hamster passed blood in the stools. So, there should be blood in the anus. A case of wet tail well known amongst hamster owners. Yet I saw blood in the vulval area and the anal opening appeared abnormally small. After all, this was a dwarf hamster and I don't see anal openings in all hamsters I examined, unlike in the dog and cat. So, I did not think of atresia ani - the failure of the anus to open during development. This was a 2.5-year-old hamster with no complaint of stools or diarrhoa.
No stools were passed but bloody diarrhoea for the past 2 days. An old female dwarf hamster. Bleeding from the vagina. This would be a case of pyometra as in old female dogs not spayed.
The high risk solution would be to spay the dwarf hamster to stop uterine bleeding and death. I have never spayed a hamster. I doubt almost all vets do not spay dwarf hamsters. It is just too risky. I asked Dr Daniel if he would do it. "No," he said firmly. I told the owner that this hamster is old and the risk is just too high. She would die. He said to go ahead. I said this was inoperable.
The hamster's abdomen was very swollen. She would die if not operated. If operated, she might or might not die. Likely to die. An exploratory laparotomy to open the abdomen to check and remove the uterus. The anaesthesia must be just right. Not too little as the hamster would move. Not too much as the hamster would be dead. How much is not too little or too much?
I gave Zoletil 50 0.01 ml IM. Insufficient. Too little. The hamster looked at me. I put her under 5% isoflurane gas + Oxygen till she appeared drowsy. Not more than a few seconds. She did not struggle during the surgery.
The colon was over-distended, probably due to twisting. I massaged it and copious amount of red bloody stools flowed out (see image). I closed the abdomen with 6/0 sutures interrupted. The hamster was drowsy. I injected 0.2 ml Hartmann + glucose + baytril. It was already 5 pm on this fine Sunday afternoon of Feb 23, 2014. The hamster was alive but for how long?
On Monday, at 9 am, she was alert and walking. The tissue papers were blood stained in several areas. Those were bloody stools still passed out after surgery. I took videos.
.
TP 44844
Dwarf hamster, F, 2.5 years, 39 g
"My dwarf hamster passed blood in the stools for the last 2 days," the gentleman said.
"Did she pass the normal stool pellets?" I asked.
"None at all in the last 2-3 days. Maybe, a small pellet recently."
"Any urine passed?" I asked as this hamster had a swollen abdomen as if she was pregnant.
"I was overseas for the last 2 weeks and my family members fed her chym sim instead of the normal hamster pellets and seeds."
Blood appeared in the vulval area but the owner said the hamster passed blood in the stools. So, there should be blood in the anus. A case of wet tail well known amongst hamster owners. Yet I saw blood in the vulval area and the anal opening appeared abnormally small. After all, this was a dwarf hamster and I don't see anal openings in all hamsters I examined, unlike in the dog and cat. So, I did not think of atresia ani - the failure of the anus to open during development. This was a 2.5-year-old hamster with no complaint of stools or diarrhoa.
No stools were passed but bloody diarrhoea for the past 2 days. An old female dwarf hamster. Bleeding from the vagina. This would be a case of pyometra as in old female dogs not spayed.
The high risk solution would be to spay the dwarf hamster to stop uterine bleeding and death. I have never spayed a hamster. I doubt almost all vets do not spay dwarf hamsters. It is just too risky. I asked Dr Daniel if he would do it. "No," he said firmly. I told the owner that this hamster is old and the risk is just too high. She would die. He said to go ahead. I said this was inoperable.
The hamster's abdomen was very swollen. She would die if not operated. If operated, she might or might not die. Likely to die. An exploratory laparotomy to open the abdomen to check and remove the uterus. The anaesthesia must be just right. Not too little as the hamster would move. Not too much as the hamster would be dead. How much is not too little or too much?
I gave Zoletil 50 0.01 ml IM. Insufficient. Too little. The hamster looked at me. I put her under 5% isoflurane gas + Oxygen till she appeared drowsy. Not more than a few seconds. She did not struggle during the surgery.
The colon was over-distended, probably due to twisting. I massaged it and copious amount of red bloody stools flowed out (see image). I closed the abdomen with 6/0 sutures interrupted. The hamster was drowsy. I injected 0.2 ml Hartmann + glucose + baytril. It was already 5 pm on this fine Sunday afternoon of Feb 23, 2014. The hamster was alive but for how long?
On Monday, at 9 am, she was alert and walking. The tissue papers were blood stained in several areas. Those were bloody stools still passed out after surgery. I took videos.
.
Saturday, February 22, 2014
1340. Myanmar stories - The nursing aide shortage in Singapore
Saturday Feb 21, 2014
On Thursday, I met an employment agent at Khin Khin Employment Agency. Vitalline would be around 60 years old and specialises in placement of nurses and nursing assistants.
He came to get a letter from Khin Khin's company in Myanmar to apply for a business visa to visit Myanmar to interview nursing assistants. A business visa permits mulitple entries but he had not been to Myanmar for the last 2 years since he had a good supply. But in 2014, he has a drought as the government tightens the rules owing to social discontent with too many foreigners.
"When I asked the Myanmar agents, they would supply me one or none," he lamented. So, he sought Khin Khin's help, offering $600 in wages and $500 for accommodation. Khin Khin, being a Myanmarese, knows all the employment agents in Yangon and could communicate with them anytime. She said she could get at least 20 prospects. The veteran would meet the agents when he goes to Myanmar on Feb 27, 2014 but he needed a Myanmar company to sponsor him for the visa application. So, Khin Khin asked me to help write this letter and I had the draft to her manager Soe. .
I re-typed Soe's letter to inform the embassy that he would be invited to Myanmar for a business discussion as her assistant could not or would not learn how to type a business letter. His layout of the letter was bad. He typed Vitalline's name in Capital letters. Instead of wasting time, I just typed the letter for him.
"Your letter is written well, like a Singaporean," he complimented me. He was a busy man and any person in Khin Khin's office must be Myanmarese since they appear to speak Greek amongst themselves. English grammar is hard to master but the Myanmar language is even harder.
Singapore's population is aging and locals don't want to be nursing assistants. So, there is a great demand for such workers. Myanmar is prospering in the last 2 years and so only high wages would attract some to come. The worry is people trafficking and Vitalline could be charged for that offence if he goes toYangon to do his own interviews without licensed employment agents there. He can't just advertise and meet the prospects.
On the very next afternoon, I was at Khin Khin's office. Two ladies working in Singapore as nursing aides came to enquire about jobs. Khin Khin shouted at them for some reasons. "They are just wasting my time fishing and asking lots of questions," she told me.
"How do you expect them to get jobs if they don't ask questions. Be patient," I advised. "These are 2 prospects for Vitalline and you need not share the commission with your Yangon agent!" Sometimes, I think Khin Khin has no business acumen. Or she just want mega deals like the real estate development of $45 million dollars she had handled, taking so much time and not closing.
I talked to the 2 ladies asking them how much they are paid as work permit holder and how many years they had worked. "$350 with free food and lodging," the younger one had worked a few months.
"The offer is $600 and $500 for lodging," Khin Khin had a carrot for them. So they would be referred to Vitalline and would get better pay.
On Thursday, I met an employment agent at Khin Khin Employment Agency. Vitalline would be around 60 years old and specialises in placement of nurses and nursing assistants.
He came to get a letter from Khin Khin's company in Myanmar to apply for a business visa to visit Myanmar to interview nursing assistants. A business visa permits mulitple entries but he had not been to Myanmar for the last 2 years since he had a good supply. But in 2014, he has a drought as the government tightens the rules owing to social discontent with too many foreigners.
"When I asked the Myanmar agents, they would supply me one or none," he lamented. So, he sought Khin Khin's help, offering $600 in wages and $500 for accommodation. Khin Khin, being a Myanmarese, knows all the employment agents in Yangon and could communicate with them anytime. She said she could get at least 20 prospects. The veteran would meet the agents when he goes to Myanmar on Feb 27, 2014 but he needed a Myanmar company to sponsor him for the visa application. So, Khin Khin asked me to help write this letter and I had the draft to her manager Soe. .
I re-typed Soe's letter to inform the embassy that he would be invited to Myanmar for a business discussion as her assistant could not or would not learn how to type a business letter. His layout of the letter was bad. He typed Vitalline's name in Capital letters. Instead of wasting time, I just typed the letter for him.
"Your letter is written well, like a Singaporean," he complimented me. He was a busy man and any person in Khin Khin's office must be Myanmarese since they appear to speak Greek amongst themselves. English grammar is hard to master but the Myanmar language is even harder.
Singapore's population is aging and locals don't want to be nursing assistants. So, there is a great demand for such workers. Myanmar is prospering in the last 2 years and so only high wages would attract some to come. The worry is people trafficking and Vitalline could be charged for that offence if he goes toYangon to do his own interviews without licensed employment agents there. He can't just advertise and meet the prospects.
On the very next afternoon, I was at Khin Khin's office. Two ladies working in Singapore as nursing aides came to enquire about jobs. Khin Khin shouted at them for some reasons. "They are just wasting my time fishing and asking lots of questions," she told me.
"How do you expect them to get jobs if they don't ask questions. Be patient," I advised. "These are 2 prospects for Vitalline and you need not share the commission with your Yangon agent!" Sometimes, I think Khin Khin has no business acumen. Or she just want mega deals like the real estate development of $45 million dollars she had handled, taking so much time and not closing.
I talked to the 2 ladies asking them how much they are paid as work permit holder and how many years they had worked. "$350 with free food and lodging," the younger one had worked a few months.
"The offer is $600 and $500 for lodging," Khin Khin had a carrot for them. So they would be referred to Vitalline and would get better pay.
1339. Singapore stories. The girl with a tattooed "sleeve"
Saturday Feb 21, 2014 9.20am
I took the subway since my car is being borrowed by a young man whose friend is getting married. It is refreshing and good exercise to walk in the bright sunshine morning, taking bus and train to my office.
On the train, I saw a "red head" slim girl in bright green dress, fair complexion, eye lashes long, her reddish brown hair shining in the sunlight. Finger nails with the additional false patterned nails, except her forefinger. Blue shoulder bag on right shoulder and left shoulder has a black bag. Pink slippers. Toes painted green. I noticed Digit 4 on both legs were clubbed. From the right side, I thought she wore an unusual sleeved blouse with a fierce-looking skull and grinning teeth. It was a tattoo on her right upper arm. The left arm was bare. A tattoo appeared from the left cleavage, peeping from the neck line of her dress. 2 red ear pieces attached to her smartphone as she furiously scrolled the screen. Age around late 20s. Unlikelys to be going downtown to work. I alighted at Toa Payoh station and she was still scrolling.
On alighting from the bus 238 opposite the Hindu temple, I met one industrial park tenant who sells plumbing and pipes."What's happened to the old man book-binder?" This man wanted to retire and had asked me for $40,000 to take over. New HDB rulings say that the new tenant will have to return the shop and not assign. So we thought he would have no takers. He had an offer of $25,000 from the air-cond neighbour.
"Well, he does not open on Saturday. In fact he will close in July."
"How much did he sell his shop?" I asked.
"$45,000," he said. "Two lady realtors came and got him to close the deal."
The 75-year-old man got what he wanted and $5,000 more. He did not need to work and his children had asked him to stop work. He was working half-day anyway and had some orders from the government to bind books for funeral services of important people. There was no more apprentices like him to learn the trade and so all skills are gone. At least he has got $45,000 to smell the roses. Realtors who walk the neighbourhood can be quite successful in closing deals too.
I took the subway since my car is being borrowed by a young man whose friend is getting married. It is refreshing and good exercise to walk in the bright sunshine morning, taking bus and train to my office.
On the train, I saw a "red head" slim girl in bright green dress, fair complexion, eye lashes long, her reddish brown hair shining in the sunlight. Finger nails with the additional false patterned nails, except her forefinger. Blue shoulder bag on right shoulder and left shoulder has a black bag. Pink slippers. Toes painted green. I noticed Digit 4 on both legs were clubbed. From the right side, I thought she wore an unusual sleeved blouse with a fierce-looking skull and grinning teeth. It was a tattoo on her right upper arm. The left arm was bare. A tattoo appeared from the left cleavage, peeping from the neck line of her dress. 2 red ear pieces attached to her smartphone as she furiously scrolled the screen. Age around late 20s. Unlikelys to be going downtown to work. I alighted at Toa Payoh station and she was still scrolling.
On alighting from the bus 238 opposite the Hindu temple, I met one industrial park tenant who sells plumbing and pipes."What's happened to the old man book-binder?" This man wanted to retire and had asked me for $40,000 to take over. New HDB rulings say that the new tenant will have to return the shop and not assign. So we thought he would have no takers. He had an offer of $25,000 from the air-cond neighbour.
"Well, he does not open on Saturday. In fact he will close in July."
"How much did he sell his shop?" I asked.
"$45,000," he said. "Two lady realtors came and got him to close the deal."
The 75-year-old man got what he wanted and $5,000 more. He did not need to work and his children had asked him to stop work. He was working half-day anyway and had some orders from the government to bind books for funeral services of important people. There was no more apprentices like him to learn the trade and so all skills are gone. At least he has got $45,000 to smell the roses. Realtors who walk the neighbourhood can be quite successful in closing deals too.
Thursday, February 20, 2014
1338. The old Terrier from Bukit Batok could not stand on his hind legs for 2 days
I was surprised to see this 14-year-old Terrier X from Bukit Batok again, as many dog owners will go to the nearest vet and now there are 60 vet surgeries in Singapore.
The dog recovered the next day and I sms the young lady owner as she did not answer her phone. She sms back. We don't talk by phone nowadays, esp with busy young people.
1336. Myanmar stories: Tonsillolith. Fortune teller's prediction was accurate
Feb 19, 2014
Khin Khin had profuse bleeding in her mouth, with "large clots" coming out while she was in Myanmar for a few weeks to attend to her 92-year-old aged mother's affairs and business. She consulted the famous fortune teller whom I had met in Feb 2014 on a visit to his farm with Khin Khin. "He said not to worry, nothing serious."
I have an open mind. Some people may have the gift of telling the future. In Singapore, the kind-hearted Dr Chan from SGH's Otorlaryngoloy Department examined her early instead of Mar 19, 2014. She was worried about oral cancers growing in her mouth and sought my help to get an earlier appointment. "Nothing to worry about," Dr Chan told her. "If you wish, go for a neck MRI but it is not necessary. You have got a tonsillolith in your right tonsils." That is the diagnosis. For Khin Khin, the explanation was a "stone". A stone in the crypt of the tonsils causing bleeding which has stopped recently.
"Why is it that I can get a tonsil stone?" Khin Khin asked me.
"I don't know," I viewed the image of the tonsils taken by Dr Chan's nasal endoscopy to look for the stones. "Some people get bladder stones or gall bladder stones. I have not heard of anybody getting tonsillar stones. His report says it is on the right tonsil. Did you bleed from the right side of the mouth? "
"Yes," she felt her right mandibular area. "Right side."
Khin Khin had profuse bleeding in her mouth, with "large clots" coming out while she was in Myanmar for a few weeks to attend to her 92-year-old aged mother's affairs and business. She consulted the famous fortune teller whom I had met in Feb 2014 on a visit to his farm with Khin Khin. "He said not to worry, nothing serious."
I have an open mind. Some people may have the gift of telling the future. In Singapore, the kind-hearted Dr Chan from SGH's Otorlaryngoloy Department examined her early instead of Mar 19, 2014. She was worried about oral cancers growing in her mouth and sought my help to get an earlier appointment. "Nothing to worry about," Dr Chan told her. "If you wish, go for a neck MRI but it is not necessary. You have got a tonsillolith in your right tonsils." That is the diagnosis. For Khin Khin, the explanation was a "stone". A stone in the crypt of the tonsils causing bleeding which has stopped recently.
"Why is it that I can get a tonsil stone?" Khin Khin asked me.
"I don't know," I viewed the image of the tonsils taken by Dr Chan's nasal endoscopy to look for the stones. "Some people get bladder stones or gall bladder stones. I have not heard of anybody getting tonsillar stones. His report says it is on the right tonsil. Did you bleed from the right side of the mouth? "
"Yes," she felt her right mandibular area. "Right side."
Tuesday, February 18, 2014
1335. AUDIT. A female Sheltie had blood in the urine 6 years ago
TP XX761
Sheltie, F, Born Sep 28, 2006
Feb 18, 2014. Owner came to buy a small 2 kg bag of canine C/D. His last purchase of a small bag was in Nov 29, 2013. I met him and he explained that he purchases C/D from the associate vet in Jurong whose practice is near his office and only when there is no stock, he would come to Toa Payoh Vets.
So far the dog is OK but no urine tests have been done.
"It is difficult to collect the urine from a female dog," he said today when I advised urine test.
Some owners can do it but it needs patience. The vet could collect using urethal catheterization but most owners are not keen.
"Use a syringe to suck up the urine after she pees," I said since this was a compromise. "Will it be suitable for testing?"
"It is cheaper to buy the C/D diet," the man in his late 50s told me. "The operation done by your vet in Jurong costs me $2,000. A big stone of over 2 cm plus several small ones were removed and also seen in the X-ray." I got the clinic to send over to me the stone analysis and tests. The stones were struvites. The dog could not pee and so the owner wanted an urgent operation in April 5, 2013.
On review of the medical records, the dog had "smelly urine" in Aug 3, 2008. The owner had some antibiotics and did not have any complaints till April 2013 when the dog could not pee. It is hard to get owners to do the urine tests which will be best practice to check for urinary tract infection and pH.
They prefer just to buy the prescription diet and that's it.
Sheltie, F, Born Sep 28, 2006
Feb 18, 2014. Owner came to buy a small 2 kg bag of canine C/D. His last purchase of a small bag was in Nov 29, 2013. I met him and he explained that he purchases C/D from the associate vet in Jurong whose practice is near his office and only when there is no stock, he would come to Toa Payoh Vets.
So far the dog is OK but no urine tests have been done.
"It is difficult to collect the urine from a female dog," he said today when I advised urine test.
Some owners can do it but it needs patience. The vet could collect using urethal catheterization but most owners are not keen.
"Use a syringe to suck up the urine after she pees," I said since this was a compromise. "Will it be suitable for testing?"
"It is cheaper to buy the C/D diet," the man in his late 50s told me. "The operation done by your vet in Jurong costs me $2,000. A big stone of over 2 cm plus several small ones were removed and also seen in the X-ray." I got the clinic to send over to me the stone analysis and tests. The stones were struvites. The dog could not pee and so the owner wanted an urgent operation in April 5, 2013.
On review of the medical records, the dog had "smelly urine" in Aug 3, 2008. The owner had some antibiotics and did not have any complaints till April 2013 when the dog could not pee. It is hard to get owners to do the urine tests which will be best practice to check for urinary tract infection and pH.
They prefer just to buy the prescription diet and that's it.
1334. AUDIT. An old male dog passes blood in the urine
TP XX803 Male, toy poodle, white, not neutered
Feb 17, 2014
"My dog passes blood in the urine at 7 am today. Not eating today too. Very tired looking." the woman said.
"Did he drink a lot?"
"I don't see him drinking but the stools are OK."
I palpated the bladder area. The dog winced in pain. The owner did not want a blood test but gave permission for the urine test and X-rays.
"My dog had a blood test before," she said. I checked the records. The dog had a high total white cell count of 49.2 (6-17) on Sep 8 2013. The complaint was blood in the urine, licking of the penis, diarrhoea and not eating for 2 days. Two years ago, Vet 1 had said that the dog would die under general anaesthesia if dental extracton of the rotten loose teeth was performed. Vet 1 said she was old, had heart disease and so would die on the operating table.
The owner did not do it. The dog had foul breath for the past 2 years and was drooling in this Sep 2013 visit. But drooling was present in the past 2 years too. Regular dental check up from 2 years of age every year would have prevented this situation from developing. Dr Daniel had the loose teeth extracted and the dog was OK as the owner said: "It is the bad teeth causing drooling and the high white cell count!" Owners are quite sophisticated as regards blood test results.
Feb 17, 2014
"My dog passes blood in the urine at 7 am today. Not eating today too. Very tired looking." the woman said.
"Did he drink a lot?"
"I don't see him drinking but the stools are OK."
I palpated the bladder area. The dog winced in pain. The owner did not want a blood test but gave permission for the urine test and X-rays.
"My dog had a blood test before," she said. I checked the records. The dog had a high total white cell count of 49.2 (6-17) on Sep 8 2013. The complaint was blood in the urine, licking of the penis, diarrhoea and not eating for 2 days. Two years ago, Vet 1 had said that the dog would die under general anaesthesia if dental extracton of the rotten loose teeth was performed. Vet 1 said she was old, had heart disease and so would die on the operating table.
The owner did not do it. The dog had foul breath for the past 2 years and was drooling in this Sep 2013 visit. But drooling was present in the past 2 years too. Regular dental check up from 2 years of age every year would have prevented this situation from developing. Dr Daniel had the loose teeth extracted and the dog was OK as the owner said: "It is the bad teeth causing drooling and the high white cell count!" Owners are quite sophisticated as regards blood test results.
1333. An emaciated paralysed dog in Singapore
"Just have a look and tell the AVA that the dog is OK," the man brought in a very thin rib-showing cross-bred. He finally had a summons if he did not get the dog a veterinary examination.
"The dog is paralysed in his hind legs with two foot sore but that does not mean that she will become so thin," I got some pain in the thoraco-lumbar region and weak pedal reflexes of both hind limbs. "Unless he is not given sufficient food or has a disease. Paralysed dogs can gain more weight as they don't walk much. I need to do a blood test. "
"Please don't tell the AVA that I have ill-treated my dog," the man had reared the dog from puppyhood and now she is 13 years old. That would be considered aged.
"Was there a car accident earlier?" I asked.
"She ran out of the house 2 years ago but came back OK. Later she was wobbly and after that paralysed."
The blood test showed high ALT and urea levels but the haematology was normal. There was spinal pain at the T9-11 area and the pedal reflexes of the hind paws were poor. Two bed sores on each hind paw were large at 2 cm x 3 cm. The dog looked alert and her coat was in good condition.
"My dog does not like dry food," the man said that his dog at 50:50 wet and dry food. He would bring samples for me to see. It is hard to assess whether this is a case of under-feeding or the dog being a fussy eater over the years, leading to this condition.
I advised more dry food of good quality to be fed and warm water to shampoo off the urine smell off the back area. I would submit a report to the AVA care of him. X-rays, faecal worm tests, neoplasia checks of abdomen, exocrine pancreatic deficiency were not done as medical costs were a concern. This is a case where the owner shows that he cares for the old dog as others would just euthanase her.
"Some concerned animal lovers may have reported you to the AVA," I said to the man. "Your dog is paralysed and very thin. It can be a case of dog abuse and so the AVA needs to respond to the public complaint. The AVA is very busy with budget cuts nowadays. So I don't think the officers go around Singapore checking on the dog's health."
Overall, the dog is in "good" condition as regards blood test and alertness. It is just that she is very thin.
On Feb 20, 2014, I submitted a veterinary report to the owner for the AVA. This is a strange case as paralysed dogs do put on weight if they are in good health or fed much more. I can't say whether he has underfed his dog or the dog is a finicky eater.
"The dog is paralysed in his hind legs with two foot sore but that does not mean that she will become so thin," I got some pain in the thoraco-lumbar region and weak pedal reflexes of both hind limbs. "Unless he is not given sufficient food or has a disease. Paralysed dogs can gain more weight as they don't walk much. I need to do a blood test. "
"Please don't tell the AVA that I have ill-treated my dog," the man had reared the dog from puppyhood and now she is 13 years old. That would be considered aged.
"Was there a car accident earlier?" I asked.
"She ran out of the house 2 years ago but came back OK. Later she was wobbly and after that paralysed."
The blood test showed high ALT and urea levels but the haematology was normal. There was spinal pain at the T9-11 area and the pedal reflexes of the hind paws were poor. Two bed sores on each hind paw were large at 2 cm x 3 cm. The dog looked alert and her coat was in good condition.
"My dog does not like dry food," the man said that his dog at 50:50 wet and dry food. He would bring samples for me to see. It is hard to assess whether this is a case of under-feeding or the dog being a fussy eater over the years, leading to this condition.
I advised more dry food of good quality to be fed and warm water to shampoo off the urine smell off the back area. I would submit a report to the AVA care of him. X-rays, faecal worm tests, neoplasia checks of abdomen, exocrine pancreatic deficiency were not done as medical costs were a concern. This is a case where the owner shows that he cares for the old dog as others would just euthanase her.
"Some concerned animal lovers may have reported you to the AVA," I said to the man. "Your dog is paralysed and very thin. It can be a case of dog abuse and so the AVA needs to respond to the public complaint. The AVA is very busy with budget cuts nowadays. So I don't think the officers go around Singapore checking on the dog's health."
Overall, the dog is in "good" condition as regards blood test and alertness. It is just that she is very thin.
On Feb 20, 2014, I submitted a veterinary report to the owner for the AVA. This is a strange case as paralysed dogs do put on weight if they are in good health or fed much more. I can't say whether he has underfed his dog or the dog is a finicky eater.
Sunday, February 16, 2014
Sunday's interesting case - A papillon with fits from Tampines is active now
TPXX284
Sunday Feb 16, 2014
"Do you remember my old dog with fits for 2 days and kidney failure?" the woman in her late 30s walked in and told me the name of her dog. "A small black and white dog" she held both hands apart to indicate the size of the Papillon.
"I can't remember as there are many old dogs with kidney failure and fits," I took out the medical records while the lady had her own 2 receipts. The dog had 12 rotten teeth extracted on Jan 12, 2014 by me. Blood test had indicated kidney failure with high counts of urea at 64 and creatinine 260. Neutrophil % was high at 86% but total white cell count was normal. Blood calcium was low but glucose was normal.
"Cha Cha has good appetite and is very active," she said. "Luckily I didn't put her to sleep!"
She syringed 50 ml water 2x/day daily and fed k/d canned food with rice and minced chicken. The dog just ate all.
I did not expect to hear from owners. After all this dog was aged at 13 years old. But he is as active as can be.
"I think the fits are due to his rotten teeth," the lady said. I agreed as there were no more fits since dental extraction. No more lethargy and staggering. A positive outcome and no euthanasia as advised by her friends justifying that the dog was old and had fits.
I advised k/d for 3 months and take a blood test. It is difficult to advise based on recovery. This was a case referred by her friend to me and only positive outcomes can generate referrals in medicine and surgery. Fortunately the dog did not die under general anaesthesia (using isoflurane gas only). Otherwise, no happy ending from the lady in Tampines as the vet gets the blame when death on the operating table occurs.
Yearly dental check up will be best for dogs over 5 years but Singaporeans are too busy to do it. So, many aged dogs have foul breath and loose teeth. Painful mouth ulcers and tooth ache can lead to fits. This was a surprisingly good outcome case as I thought old dogs with fits will not live long. But here he is. Good appetite and active.
Sunday Feb 16, 2014
"Do you remember my old dog with fits for 2 days and kidney failure?" the woman in her late 30s walked in and told me the name of her dog. "A small black and white dog" she held both hands apart to indicate the size of the Papillon.
"I can't remember as there are many old dogs with kidney failure and fits," I took out the medical records while the lady had her own 2 receipts. The dog had 12 rotten teeth extracted on Jan 12, 2014 by me. Blood test had indicated kidney failure with high counts of urea at 64 and creatinine 260. Neutrophil % was high at 86% but total white cell count was normal. Blood calcium was low but glucose was normal.
"Cha Cha has good appetite and is very active," she said. "Luckily I didn't put her to sleep!"
She syringed 50 ml water 2x/day daily and fed k/d canned food with rice and minced chicken. The dog just ate all.
I did not expect to hear from owners. After all this dog was aged at 13 years old. But he is as active as can be.
"I think the fits are due to his rotten teeth," the lady said. I agreed as there were no more fits since dental extraction. No more lethargy and staggering. A positive outcome and no euthanasia as advised by her friends justifying that the dog was old and had fits.
I advised k/d for 3 months and take a blood test. It is difficult to advise based on recovery. This was a case referred by her friend to me and only positive outcomes can generate referrals in medicine and surgery. Fortunately the dog did not die under general anaesthesia (using isoflurane gas only). Otherwise, no happy ending from the lady in Tampines as the vet gets the blame when death on the operating table occurs.
Yearly dental check up will be best for dogs over 5 years but Singaporeans are too busy to do it. So, many aged dogs have foul breath and loose teeth. Painful mouth ulcers and tooth ache can lead to fits. This was a surprisingly good outcome case as I thought old dogs with fits will not live long. But here he is. Good appetite and active.
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