Monday, September 15, 2014

1501. A 5-month-old cat has difficulty peeing. Why?

Sep 15, 2014

Cat, M, Not neutered, 5 m. Cannot pee normally.

"Did he try to mate with the female cat?" I asked the young lady who had adopted this cat 4 months ago and noted that he was peeing outside the litter box last month.
"No," she said. "But the 5-month-old female always lick his private parts."

A tense round swelling in which the centre is a preputial opening and in which urine would shoot out once I expressed the anaethesized cat's bladder.

My assistant aspirated over 15 ml of urine and some blood and we showed the container of urine to the lady. The swelling had shrank to a normal size.

When we showed the area to the owner, it swelled again back to its original size of 3 cm x 3 cm x 2 cm. It was as if there was a leak from the bladder deep inside the swelling. Aspiration by needle was not a solution to this problem. Could there be a hole in the penile urethra?  Hard to tell without more costly imaging.

I anaesthesized the cat with isoflurane and gas again. I incised 6mm midline from the preputial opening. Thick red granulomatous tissue under the skin. Red blood oozed out from the thickened tissues. Urine also seeped out. The swelling now shrank.

Hospitalised the cat overnight and gave anti-inflam and antibiotics. A rare case of possible urethral rupture juding by the hardened granulomatous tissue under the big preputial swelling. The female cat could have bitten him during mating. The owner may say no mating but she could not be around 24 hours a day to monitor this cat.  Female cats bite when mated, as part of the stimulus for ovulation and so this male cat could have got badly injured in his prepuce. There was infection and a some drops of pus oozing out during incision.  

On Day 3 of in-patient treatment, the cat's preputial swelling has gone down by 60%. He could pee inside his litter box and was very active and very playful. He went home to a happy owner. Mating does have hazards for the feline male as the female may bite when mated. In this case, the female cat had continually licked the injured male's preputial area.  

1500. A veterinary trilogy - swellings below the right eye

Sep 14, 2014 Sunday

A trilogy is a set of 3 works of art that are connected, commonly found in literature, films and video games. They are connected by characters, settings or theme.

In my veterinary example, the 3 old dogs have swellings below the right eye seen by me within a short period of time.

Case 1. A 15-year-old Cross-bred had facial cysts.
Case 2. A 15-year-old Jack Russell had carnaissal tooth abscess and oronasal fistula.
Case 3. A 11-year-old Jack Russell had chronic dacryocytitis

All 3 with different causes but the same surgical outcomes. They have recovered as at Nov 17, 2014

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1499. A 4-year-old terrapin has swollen eyelids

Sep 14, 2014  Sunday

"We went for holidays for 3 days," the Singapore school holiday week started in September for the 8-year-old and 4-year-old daughters.  They put the nameless terrapin in the little tank which now has no space for swimming since she has grown much bigger at 450 g. She is as big as the palm size of a big man and the tank was meant for a terrapin of a few weeks old.  

"When we came back, the turtle is not eating the shrimps. She would snap and eat the shrimps hungrily every day.  She also has swollen eyes!"

"The eyelids are swollen," I said. "The eyes could be infected as she was in the water for 3 days when you were away."




"It could be that she had no sunlight," the father said. "I will upgrade to a bigger tank and buy the lighting system."

"The shell quality is poor, with cracks and unevenness on the surface," I said. "If she eats shrimps only, she will not get good nutrition.  It is fortunate that she has not lung infection as she does not gasp for air, like the other terrapins I treated. That is because you come early for treatment."

 Medication, eye drops and multivitamins were prescribed. New bigger tank, a basking platform and sufficient amount of water to swim. Changing of water used to be once in 2 days. Variety of food like live guppies, egg yolk.  She dislikes vegetables.

UPDATE
Follow up the next day. Terrapin's eyelids much less swollen. Still not eating. New tank bought. I advised feeding shrimps and medication in the water.
Video shows terrapin snapping at shrimps.










FOLLOW UP ON SEP 15, 2014
"We bought a bigger tank and she would be swimming," the wife answered the phone. "There is also lighting. But she does not eat the shrimps."

"Are the eyelids swollen?"
"Much less than yesterday," she said.
Still too early to recover.

The 8-year-old daughter in Primary 2 can be trained to change water or take more care of the terrapin but most Singaporean parents just do it. The 4-year-old is too young.

FOLLOW UP ON SEP 17, 2014 when I sms to ask whether the turtle is eating shrimps.
"Yes, the turtle is eating dry shrimps in the water. We are trying to get her to feed on vegetables and turtle food (pellets). The swollen eye is better and we plan to consult you again when the eye drops are used up. Thank you."

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1498. Is it worth operating an old female dog with breast cancer?

Sep 15, 2014

Besides the risk of death from anaesthesia, owners do weigh the medical costs of removing the breast tumours from the 14-year-old Silkie Terrier. The total costs of removing all 7 breast tumours including anaesthesia was $700 in this case.

First I advised spaying to get rid of the ovarian hormones feeding the breast tumours.  Breast tumours to be excised 4 weeks later. But many Singaporean owners don't follow up with breast tumour removal.

HISTORY
Nov 2, 2013   Dog could not lie down on chest.  Large breast tumours grow large during last few days.  Large swelling of left MG5, right MG 1 +2. No blood tests, chest X-ray to check for metastasis nor biopsy to check for malignancy to lower medical costs.

Nov 5, 2013. Spayed.

Jul 3, 2014.  Left MG5 swollen and painful.  Other tumours did not increase in size. I advised removal of left MG5 2 weeks later after giving anti-inflam and antibiotics.

Sep 15, 2014. Owner wanted painkillers  + injections as the left MG5 is swollen to 6cm x 6 cm x 3 cm and was very painful. The dog was active but would not permit carrying.
I advised removal after 2 weeks. But the owner felt that the dog's lifespan was ending. "You said 6 months to live," the husband told me.

"I said 6 months based on the dog not spayed and the fast-growing breast tumours." It is best not to predict the life span as there could be mis communications.  



Friday, September 12, 2014

1497. A severely constipated cat. What to do?

Sep 12, 2014

The expatriate lady and her young daughter brought in a small sized cat that was straining to poop for the past 5 days with no stools. A male, neutered, 2 years old, stripped brown at 2 kg. Looks like a miniature domestic shorthaired.

He did not want to come out of the carrier. So I waited patiently. After some time, he came out himself, sniffed the air and walked on my consultation table edge, ready to leap away.

"He seldom meet strangers," the European lady said as this cat hissed several times.
"Just stroke his neck and talk to him," I said to the mother. "I can palpate his abdomen. I can feel a solid rock of 10 cm x 10 cm in his rectum. He is badly constipated."

What to do now?

"I need to sedate him to give him the enema," I said.
"I can wrap him in a towel and you can do it," the lady suggested.
"Not so easy as you think. When the tip of the enema tube touches his anus, he will claw and jump away!"

"I will need to sedate him," I prepared xylazine 0.1 ml + ketamine 0.4 ml to be given IM. My assistant would hold the scruff of the cat's neck. But he was not that keen to do so as the cat already warned us by hissing again.

"Quickly let him back into the carrier," I said. He faced the carrier and walked in for shelter and sat down.

"We must not excite him much as there is no 2nd chance once he is frightened."

"I want to see him sedated," the lady was not keen on scruffing the cat.

So, I got the cat carrier covered by a big black plastic bag. Anaesthetic gas pumped into the carrier inside the bag. It took around 15 minutes. Then Naing masked the sleepy cat to maintain the anaesthesia. I pumped in one tube of Microlax enema.

"You said two," the lady reminded me as she wanted the cat to go home after this procedure.

So, 2 tubes. I advised W/D cans and wait and see for 2 days. An injection of antibiotics. The young daughter covered her nose with the top of her T-shirt as the rectal gas was smelly. "If this works, no need surgery to take out the stools."

"How did he become constipated?" the lady asked.
"Some change of surroundings. Is there a new cat? He could be stressed and stopped drinking water."
"Yes, the neighbour brought in a new cat."
So, instead of FLUTD (feline lower urinary tract disease) usually due to eating of dry food. But this cat eats only wet food, he developed constipation.

Will wait and see. The cat went home in a taxi at 6 pm. An interesting case as this cat lives in a house with garden and has free access to peeing and pooping. But a new cat has come next door.

On Sep 13, 2014, I phoned the owner but there was no response.

1496. A responsible old man

This morning I had a chat with this operator of a small cafe in a hotel. How did he do it as a one-man-operator and with diabetes?

"There are a lot of procedures to do," he said. "From switching on the computers, taking out the ice-cream from the freezer, cleaning, sweeping, making coffee and serving. Closing accounts and preparing for the next day.  I had to make sure that sandwiches are available for sale."

"How do you, as a one-man-operator serve so many people at lunch-time?" I asked.
"I will just shout e.g. sandwiches ready and the buyer will come to collect."
"Why don't you have a self-service sign?" I asked.
"Then all customers will bunch up in a queue. They can sit and wait while I call them." This was a good idea as the shop front is very short for this retail space of 200 sq. ft. Around 5 people will fill the queue.

There are educated people who would try to take advantage of this old man.

Example 1.
The insurance company held a standing buffet lunch in the hotel for its executives. This old man had rented a space where his clients could have tables and chairs to sit. One 40-year-old insurance manager sat on his table. When the old man said: "Please do not sit here as this table and chair are reserved for my customers," the manager said: "Call the security!"
"Repeat what you have just said," the old man challenged him as he was about to roll up his sleeve to sock him. The manager vacated his seat as the old man was about to grab him by his neck to yank him up.
The old man would usually ask those intruders whether they wanted to buy a drink when they sat on his chairs. "Sometimes they buy one drink and sat with their friends. I can't stop this."



Example 2.
A staff of the hotel sat on his seat without ordering any drink or food. When the old man said: "My company bought the tables and chairs for our customers," she replied: "I understand." She just would not budge.

"So what can you do?" I asked the old man.
"I went to see her manager. She must have a scolding as the next time, she put her head down whenever she passed by. I can understand that the staff may be tired, but if they ask me, I do not mind them sitting for a while to rest."   
   
From these 2 examples, you can see that this old man is responsible in earning his keep.
"How much was the income from a younger man employed before you?" I asked.
"Around $40 per day. The store was losing at least a thousand dollars. He would close the shop for smoking or for his one-hour lunch. I don't close for lunch."

By being proactive and caring for his employer's need to get sales income, the shop now loses much less money as its income is around $150 per day. He works 6 days a week.

"Will your boss be renewing the leasing contract at the end of the year?" I asked.
"No," he said. "The hotel management wants to increase rentals."  In Singapore.as in Hongkong,  every retail landlord wants to increase rental on renewal. So it is hard for small operators.

I have no doubt that this old man could get a job easily and hope he would take good care of his diabetic control. 
 

1495. A Shih Tzu put on diapers for one year

The maid stapled the diapers to make sure that the urine does not seep onto the floor. The dog came as he was not eating and was lethargic. This 11-year-old male intact Shih Tzu had been dribbling urine for one year and the diapers were the solution. The penile and preputial areas became swollen and infected. A strong urinary smell filled the air in the consultation room. The dog bit anyone who touched his belly area.

Urinary catherisation after muzzling. No urethral obstruction.

URINE TESTS

BLOOD TESTS

X-RAYS - bladder stones. What to do?





Spoke to owner
1.  Thought urinary incontinence - dribbling of urine was due to old age and so did not consult vet
2.  Whether bladder stone removal can cure the incontinence? he asked.  "I can't guarantee as the dog has been dribbling urine for a year.

3. Wait one week and given treatment. When appetite returns, will operate.
4. Cost of bladder stone removal and anaethesia is around $800. In-patient expenses and nursing will increase cost to $1,200 at the lowest rate.

Thursday, September 11, 2014

1494. SCRIPT FOR INTERN A Cavalier King Charles has a "blackhead" in his eyelid margin. Suppurative meibomitis

"I press it and pus will come out," the lady told me. "It does not bother him but bothers me very much."

It refers to a swelling and lump on the eyelid margin of this 4-year-old Cavalier King Charles.

"It is suppurative meibomitis and usually the dog tries to rub it away, injuring the cornea and causing tearing," I explained that the eyelid margin has a phospholipid-producing sebacious gland called a meibomian gland. When it is blocked or infected, it swells.

"I don't see him rubbing his eye," the lady told me. "Why don't you just use a scalpel and cut it and let the pus come out?"

"It is not that simple," I replied. "Without anaesthetic, the dog could move a lot and my scalpel may cut into his cornea, blinding him. It is quite a big abscess and need to be excised by surgery and anaesthesia."

"How much?"
"Anaesthesia and surgery will cost around $200," I said. She said Ok.
"Has the dog eaten?"
"Yes," she wanted the surgery to be done today as she was too busy tomorrow.
"It is 10 am now. I will do it at 3 pm when the food has gone past the stomach."

Electro-surgical excision from inside the eyelid conjunctiva. Thick pus flowed out.  There was a bigger lump under the palpebral conjunctiva and the electricity sealed the bleeding blood vessels leaving a black hole of 3 mm x 3 mm.
"Do you need to stitch it?" the lady asked when she came at 3 pm.
"No need to. It will heal."





AFTER SURGERY








1494. Tail docking 2-day-old poodles

Sep 11, 2014

The owner brought the dam and 4 puppies now 2 days old. They were suckling vigorously. There seemed to be not much milk. There were worries of the dam having diarrhoea, having panting after midnight yesterday and one smallest puppy not putting on weight. The owner was worried he might die. The dam let go a big slushy pile of semi-wet stools on the consultation table as the owner had given the commercial milk powder (actually it is cow's milk) only recently, puppy kibbles, eggs, causing stomach upset..


WEIGHT AT 2 DAYS OLD
1.  Male apricot 177 g
2.  Male  brown red  161 g
3. Female apricot 143 g
4. Male apricot 120 g. 

"Check the abdomen of the puppy. If it is distended, the puppy has enough milk. Take away the 3 bigger ones and let the smallest one suckle. Milk is being produced but slowly." Not a big gush of white milk, just a thin white drop of 2 mm across from one nipple.

TAIL DOCKING
At 2 days old, it is much easier to cauterise the small blood vessels after tail docking using potassium permanganate powder. The surgical technique is to place the scissors at 45 degrees on the dorsal side of the tail. Push back the skin towards the anal area on the dorsal side. Cut. There is a skin flap on the dorsal side covering the tail bone as the retracted skin on the dorsal side springs backwards. See illustration. 

"Not to let the pups suckle for one hour. Then supervise the suckling for the next 24 hours as the dam may try to lick off the powder.  So far, so good.  




1493**. The kind 74-year-old retiree's strays cat no longer suffers from painful urination (dysuria)

Sep 11, 2014

TP 20973

The retiree is a healthy man as he does not have high cholesterol unlike many of his age.

Today, he took a bus to Toa Payoh Vets to replenish his stock of feline C/D can and dry for his beloved black and white cat, Kitty. She is 11 years old. He eats around 2 kg of dry C/D a month and the owner would come monthly to buy the 2 kg bag. Why would he do it? This is because the cat no longer suffers from blood in the urine or dysuria (difficulty in urination).

FLASH BACK TO NOV 3, 2011
Dr Vanessa unblocked the bladder as Kitty had blood in the urine. She recorded "advised urinary test" but the owner was not in favour. The cat recovered with antibiotics. No more dysuria till Jun 3, 2014. He wanted just antibiotics and no consultation. He came back on Jun 21 and Jul 18 for the antibiotics as the cat recovered after a dose.     

"It is best to do a urine test," I advised. "The cat can't be taking antibiotics forever and they may not work. X-rays of the bladder for bladder and kidney stones will be better but urine test is less expensive."   The urine test on July 19, 2014 showed pH 8, SG 1.041, Blood 4+, bacteria +, triple phosphate + crystals


I advised feline C/D and no other food, to acidify the urine and this will do away with coming for antibiotics every 2 weeks. This would cure the cat of dysuria. He trusted me and so he got a bag of 2-kg C/D dry and 10 cans of C/D. The cat really did not have dysuria and he came almost monthly to buy the prescription diet. 

SEP 11, 2014

"She is very fussy," the man ordered 4 cans of C/D. "I give her half a can of C/D and puts the other half in the fridge. She will not eat that half!"

"It may be too cold," I said. "Warm it. What did you do with the half can?"
"I give it to the stray cat who eats anything." He showed me a picture of this old stray cat of 11 years old.  Such is the life of a wandering stray cat. Can't pick and choose.

This case shows that time must be spent on client education of retirees and make a cat healthy.

This aircraft maintenance technician still feeds 4 stray cats including the one who eats anything. This poor cat walks very slowly. "He has arthritis," the man said.I asked him to snap some images of this cat standing up on his front shoulder as the man said he had painful shoulders. I prescribed tolfedine 6 mg at 2 tab/day for 4 days, rest 4 days and give 4 days. If this pain-killer works and the retiree's diagnosis is correct, this old stray cat who used to be the muscle man of the cat neighbourhood would lead a better quality of life.

He has 2 other cats at home. "One is forever a miniature," he said. "Never grow up." He showed me video images of a chimera cat (half face black and half brown) and other handsome cats. He used to feed stray cats at the airport but the manager warned him off.


  • Ingredients to help manage stress
  • Dissolves struvite stones in as little as 7 days (Average 28 days)
  • Reduces the risk of struvite & calcium oxalate stones
  • Recommended for lifelong feeding of adult cats


  • APRIL 28, 2018  9am

I used software  Waze to locate the retiree's home as it is extremely difficult to find the side street in Ang Mo Kio housing apartment. He looked very fit.
"I have just been exercising," he wobbled his lower legs and had advised me to do the same.
A bright sunshine Sat morning

I had Judy phoned him first as I left the house. He was already waiting with money to pay me.
"$120 for 2 bags," I told him that the US company had increased the price by $6.00. He paid up and left to go upstairs. I quickly grabbed my camera from my car and snapped a photo of this kind old man who cared for the other stray cat."







"The cat had great difficulty standing up," he said. "Just like me in old age"
"You can walk very well, without the tongkat (walking stick).
I promised to give him some medication for the stray cat but the cat was eating, drinking, peeing and pooping normally..


.A very kind old man as he bothered to place orders and feed the two cats including the stray cats for so many years.


REFER ANOTHER BLOG POST No. 1128   Dec 2014