1507. A 5-year-old Chow Chow suddenly had fits and salivation

Saturday Sep 20, 2014

A female non-spayed Chow Chow came in recumbent, shaking all over the body and salivating thick sticky saliva. "These fits happened only 15 minutes ago. What is the cause? Can you do something to stop the fits"

I checked her medical records. No fits before. I gave IM 5mg diazepam. The dog stopped shaking one hour later. She was very thin and full of scales and oily skin. Her eyes had rolled in eyelids and were sticky with lots of pus. IV drip and medication were given. Blood test done.

Today, the dog had recovered and was eating. The whole body would be clipped and a bath given. Ears irrigated, nails clipped. The owner did not want entropion surgery.

BLOOD TESTS

History:
Mar 12, 2013. Skin disease and 6-month haematuria. Demodectic mange and ringworm.
Total white cell count 19.8  (6-17)
Neutrophils 82.5%  (60-70%)    Abs  16.34  (3-12)
Platelet clumping noted but within normal range.

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Sep 9, 2014  Fits and salivation. Recumbent. Sudden onset.

Total white cell count 28.8  (6-17)
Neutrophils 90%  (60-70%)    Abs  25.92  (3-12)
Platelet within normal range.

Glucose  0.9  (3.9 - 6.0). Query glycolysis. Suggests to repeat.

Hypoglycaemic fits likely. No complaint of polydipsia, polyphagia and polyuria.
In fact, the dog is very thin. Skin diseases generalised, with ringworm and bacteria. The dog has recovered fully now.


CONCLUSION
A Chow Chow needs much more care than a Jack Russell. Skin diseases may need monthly reviews.
Most owners have no time. So the bacteria multiplies and infect the blood stream leading to a big increase in neutrophils which are white blood cells produced in large numbers to combat the bacterial invasion.  Medical costs of treatment will be high.

Entropion is quite common in Chow Chows. The inward rolling eyelid's eye lashes irritate the cornea, causing infection and daily pus formation. The owner does not want any surgery to evert the eyelids, resolving this problem which has persisted for the last 5 years.

If the owner does not want euthanasia, the owner needs to plan and schedule regular clipping away of the long infested patchy hairy coat with the groomer and get skin reviews with the vet.

A young Shih Tzu X vomits and purges after a stay in a Pasir Ris chalet

Sunday's interesting case  Sep 21, 2014

4 days ago, the dog went to the chalet. In Singapore, Pasir Ris chalets near the sea, are rented by the family to celebrate functions and have a BBQ.
"It was only the first night and the BBQ had not started till the next day," the dog vomited 6X and had diarrhoea 10X."
The family vet treated the next day but the dog continued vomiting and purging and so was brought to her the 2nd time. Blood tests and X-rays were "normal". 3 bottles of medication were given, but now she referred the dog to the parent branch. Ultrasound showed some inflammation in the liver, gall bladder, stomach and intestines. A foreign body in the full lumen could not be ruled out.

When the dog came to me this morning, he was most aggressive. Muzzling was done but he could take the muzzle out. "Hold by the scruff of the neck while I gave the injections," I said to my assistant. Just handling the dog with hands would not do as this male dog was very strong.

Vet 1 and the referred vet had prescribed 6 types of medications and had given injections. I palpated the abdomen. Empty except for a distended bladder. Some pain felt in the rectal area as the dog winced. Could there be bone fragments inside the rectum? X-rays may not show.

Based on the sudden onset persistent vomiting and diarrhoea in the chalet, this dog could have food poisoning. The treatment varies with different vets. For such serious cases, I would give the IV drip and anti-diarrhoea medication and let the intestines rest 48 hours, with electrolytes only for the first 48 hours. The other vets fed the dog chicken pieces and advised porridge. It may be better to advise fasting for 24-48 hours.          

1505. Feedback on lateral ear canal resection surgery. A Schnauzer has very hairy ears

Sep 20, 2014

The lady asked whether Royal Canin delivers the hypoallergenic food to her house as she finds that it is better than Science Diet Z/D. Her dog had been tested for allergies which showed that the dog was allergic to grasses and even cockroaches.

."Keeping this expensive dog indoors reduces a lot of skin itchiness," she said. "Do you remember you opened up her vertical ear canals in April?"

"Some miniature schnauzers have hairy ears and so there is not much ear v. entilation or drainage. The ears become infected. Is the dog still scratching his ears and shaking his head continuously nowadays?" I asked.  

"Very much less," she said. "My friends can't believe that he is itchy to grasses"  This feedback shows that lateral ear canal resection is effective.

"There is a need to check the horizontal ear canal," I explained to her as there is some scratching of the ears. Very little .

Royal Canin does not deliver food to the house. She found it better and so she ordered it for her dog. Today another dog owner had bought 2 large bags and so there was none available. Toa Payoh Vets do not stock up such special diets as the demand is low and we have to throw away expired ones. She would phone to order the big bags. .

1504. Blood test for an old bad-breath Jack Russell X

TP 45534

Bad breath from a distance. The owner lives with the 8-year-old male dog will not be able to smell this because his nose is sensitized to the smell.

"My friend told me I must do a dental scaling," he said to me.  The dog looked like a Norwich Terrier but he said it was a Jack Russell X.

BLOOD TEST before dental work.
Surprisingly the total white cell count was 5.6 (6-17) but the neutrophils were normal at 56.4% (60-70%) and the absolute no. of neutrophils was 3.16 (0 - 3).  Overall, the values have not changed much.

Urea 6.9 (4.2 - 6.3), creatinine 81 (89-177).

4 teeth extracted. The smell was so strong that I could smell it when placed inside the plastic bag for the owner to see.
IV BAYTRIL AND DRIP.
Usually I advised 7 days of antibiotics, but the owner wanted today (Sep 18, 2014) as he was free only once a week.  So I gave the antibiotic via the IV drip direct, to kill as much of the mouth's bacteria as possible. Dog goes home with antibiotics and painkillers oral

FOLLOW UP
On Sep 19, 14, I phoned the owner.
"No bad breath?" I asked.
"No," he said happily. "Thank you.".

1503. How to make a killer presentation

Yesterday, I attended a presentation at Delifrance said to be given a lady insurance agent who told me she would be introducing her boss to me. I was asking her about insurance for a mortgage decreasing housing loan.

Instead, the boss gave the presentation on trust and leverage while she was quiet.

What she ought to do was to plan ahead, do rehearsal with her boss and give the presentation herself as she was the primary contact. The boss is a stranger. So, I sms her a Harvard Business Review article on "How to make a killer presentation."

"It is not rocket science advising a person to get a $1 million insurance cover with a 15% downpayment and recoverable yearly premiums of $6,000/month. "Just do it," I was sure she could have done a better job as she was the contact.

"Yes, Sir, Nike, Adidas" she sms me.
"Not  Adidas mdm," I replied. "Adidas is competitor. They do not do it."
"Hahahaha."


We should try to give what the customer wants. In real estate, some agents bring clients to view houses they can't afford to rent or buy. Dog groomers insist on not clipping off the tip of the tail and the face when the owner wants a complete shave.  

 

The Shih Tzu can't control his bladder for one year

Sep 18, 2014

The Shih Tzu came in for bladder stone removal as scheduled. His urine starts to smell. When the maid removed the diapers which are worn when he goes outdoors or sleeps overnight of 8 hours, I noted that the dog released a large amount of urine.

"He does urinate into the diapers," the maid showed me dark brown urine stain inside the diapers.
"What happened is that the dog will try not to pee when you put on the diapers overnight," I explained. "His bladder gets infected by stagnant urine as he keeps the urine overnight. This has been going on for one year and so now, he dribbles urine all the time."

The dog started with urine drops one year ago. He was hospitalised by a vet for one week.
"Did the vet do an X-ray or urine test?" I asked.
"I don't think he did an X-ray," the wife said. "He told me that this dog is old and old dogs cannot control their bladder. So, he must have long-term medication."

Instead, the owner got the dog to wear diapers when he is inside the apartment as his urine drops soil the whole apartment. But on Sep 11, 201, the dog was lethargic and not eating for 2 days. So he was brought to Toa Payoh Vets. X-rays showed 3 large bladder stones. Urine test show urinary tract infection with pH = 7.0, SG 1.030, positive protein, blood 4+, bacteria 2+ and no crystals. Blood tests showed total white cell count as 47.7 (normal 6 - 17), neutrophils at 96.4% (normal 60-70%) and absolute neutrophils as 46 (normal 3-11.5).  Blood urea was higher but creatinine was lower than normal.   .

Overall, this dog had a severe bacteraemia and that was why he was not eating for 2 days.

The dog was on antibiotics and today will be operated.
"Some owners will put the dog to sleep," I explained the high anaesthetic risks for old dog surgery.

In Singapore some owners do make the male dog wear diapers to prevent urine marking and soiling the apartment. This may lead to urinary tract infection as the dog withholds the urine for long time, allowing bacteria and crystals to form over several months.

SEP 18, 2014
Surgery to open the bladder. The stones had disintegrated. The testicles were swollen 5X and adhered to the scrotal sac. The testicles with pus inside the tissues and the scrotal sacs were removed.  

1502. Tail docking in 2-day-old puppies

Tail injuries happen in dogs and cats. Tail amputation or docking surgical techniques are shared in the video. It is best that your vet does the tail docking rather than use rubber bands.

   

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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