141103A_An image of a movie called Wild

An interesting attractive movie poster

1423. How to minimise anaesthetic death risk in an old dog

1. How to minmise anaesthetic death in an old dog

Informed consent

History and physical examination
Blood test, ECG and X-rays
Sedation dosage 50% for dogs over 5 years old or not as healthy
Antidote to sedation
Emergency drugs
IV drip, antibiotics and diuretic
Intubation. Correct-sized endotracheal tube fitting trachea tightly, e.g. size 9 for this adult Sheltie
Duration of anaesthesia
Close monitoring of anaesthesia by experienced assistant
Duration of surgery
Antidote
Recovery. Not to go home immediately
Post op antibiotics and painkillers for extracted teeth


Oct 28, 2014.  A father and young adult daughter presented this gentle 7-year-old male Sheltie for dental scaling. A friend's Maltese had died after dental scaling by another vet and so the owners wbeere worried about anaesthetic death. "Dogs usually do not die under anaesthesia or after anaesthesia," I said to the father. "Unless the dog has heart disease or poor health."

A thorough physical examination showed that this Sheltie with bad breath was generally healthy in heart and lungs. The heart beats were irregular. 50% sedation  of domitor and ketamine IV calmed this nervous Sheltie.

Health screening including a complete cell count and X-rays of the chest is advised. No ECG is done.

In this case, I gave an IV drip, with IV baytril, frusemide and Vit B complex.  

It is very important to provide a very close monitoring of the maintenance of isoflurane gas at 0-2%, oxygen flow rate at 2 litres/minute to ensure that minimal anaesthesia is being given. The dog did wake up in the midst of dental scaling as the maintenance dose was 0.5%.

He was intubated again and maintained at 2%. The dog woke up fast and went home 3 hours later.  Follow up 2 days later showed that the dog is OK. The dog had been given dry dog food and milk since young. He likes only certain brands of milk. Well beloved family dog and in excellent body condition.


FOLLOW UP
Oct 28, 2014


A new client - father and young adult daughter brought in a 7-year-old male entire Shetland for dental scaling.  Their friend's Maltese had died after dental scaling in another vet practice and so they did not want to go to the practice.

"Very rarely do dogs die after waking up from anaesthesia given for dental scaling," I said. "Was the Maltese having heart diseases?"  The owners of the gentle full sized Sheltie did not know but they would avoid this friend's vet

No vet can guarantee no anaesthetic risk. Even people do die.

PHYSICAL EXAMINATION
Other than periodontal disease grade 4 (tissue attachment loss over 50%), I noted that this Sheltie had congested maroon red gums, not the normal pink ones. You can see this in the video. Why? The capillary refill time was longer than the usual 2 seconds. Blood test showed that this dog had a higher than normal amount of haemoglobin in his blood at 19.1 (12-18).  The total red cell count was normal. The haematocrit was normal too.  Platelets were normal. What does it mean? Was he fed some supplements?


BLOOD TEST on 27.10.14  Abnormal values

Urea 12.3  (4.2 - 6.3)
Creatiine 65  (89-177)
Haemoglobin 19.1 (12-18)

All the other blood values within normal limits.

FOLLOW UP - Day 2 after dental scaling
The dog was a bit tired yesterday but is Ok and eating today.

"Tartar started to build up fast in last 3 years," the father said that the dog was not given meat. "Could it be the milk making the kibbles soft?". This dog had the biggest crusty tartar I had ever seen in a dog (see image/video).

The dry dog food was  Science Diet Lamb and Rice with a brand of dog's milk since young. Dog treats were given.


ADVICES 2 DAYS LATER
No milk and treats to prevent tartar build up.
Eat dry food without milk and drink water.
Blood test 4 weeks later to check on the urea levels.

This case shows that a blood test is important for screening the health of an older dog. The owner was given the option. The blood test was done by me as this dog had an unusual congested gums.

Urine-marking and caterwauling male cat

Hi,
I have a male cat, 8 months old now. For the past few months he has been very good & well toilet trained.  Recently, for about almost 2 weeks now, he has been meowing loudly at night especially, as if he wants to go out. Also, he litters everywhere in the house when actually for the past few months he always do it in his litter box. Is it advisable to sterilize him? Will it reduce the litters? It is getting more frequent now. Also, may I know the quotations for sterilization in your clinic?
Thank you for taking time to answer my queries.

Regards,
Name of owner
Sent from my iPhone

-------------------------------------
REPLY FROM DR SING


Oct 30, 2014
Neuter will help stop urine marking n caterwauling meowing loudly. Cost is $150 including painkiller  antibiotics. Pl let me know or tel 62543326

Email query on guinea pig's vocalisation and urinary stones

Hello,

 

My husband and I have two male guinea pigs – Fred (2 ½ years old) and Alvin (1 ½ years old). About a week and a half ago, we noticed that Alvin (who is usually a very quiet piggy) started to become very vocal. Although there was nothing alarming about the noises he was making, we picked-up on the fact that Alvin was making the noises while he was going to the bathroom (usually while peeing).  Again, there was nothing concerning about the noises -  in fact, he makes the same noises when cuddling with us or while romping around the cage.  

 

Just to be safe, we decided to bring him to our local vet.  After examining Alvin, the Vet said he was likely suffering from a Urinary Tract Infection and gave us a 14 day supply of Baytril SA.  After being on the Baytril for 48 hours, we noticed that Alvin was making less noises while peeing.  We assumed the Baytril was working, but just to be sure, we brought a urine sample to the Vet (about 48 hours after Alvin started on the Baytril).

 

The urine results showed: a PH of 8.5, Blood at 3+; Calcium Carbonate Crystals at 11-20; and Amorphous Phosphate Crystal at 4-10.   I've attached a copy of the full urine analysis.

 

At first, we were told that the results had to be “re-run,” because the Vet’s staff entered in the wrong species and the lab could not properly test the urine.  Despite being told this, the Vet himself said that the results would be the same no matter what. 

 

The Vet concluded that Alvin did not have a Urinary Tract Infection, but instead had stones and would require surgery.  He called a specialist and made us an appointment for the very next morning.  It’s bewildering to me how he could come to such a conclusion, since he himself did not feel any stones and Alvin, to our knowledge, was actually doing much better.  It also begs to question why Alvin would respond to the Baytril altogether if he in fact did not even have a Urinary Tract Infection to begin with. 

 

The last three days specifically, Alvin has been 100% back to normal – he eats well, urinates without noises, poops without any problems and plays with his brother as usual.  There are no unusual urine smells (or color) and the urine itself does not feel gritty.  

 

Rather than immediately having him undergo more tests unnecessarily, we've decided to monitor him closely (my husband works from home and can watch him throughout the day).  Alvin (and Fred) are currently on a diet of Oxbow Pellets, Timothy Hay and leafy green veggies.  Admittedly, prior to this ordeal, I was feeding them far too many baby carrots (approximately 8 each – 16 total - for the entire day).  I know now those amounts were far too much and have now eliminated carrots altogether for the time being (despite having two very angry piggies on my hands).    Coincidentally, Alvin’s improvement seems to have happened at the same time as the elimination of carrots from his diet, in addition to an increase in the amount of Vitamin C he's fed. 

 

Although Alvin’s health is our top priority, and we will move mountains to ensure he is taken care of, I do not want to create any undue stress on him.  In addition to finding some fault in how the Vet handled the situation from the beginning, I also have very little faith in him, or anyone he recommends, at this point.  I have spoken with two Specialists (one of which the Vet referred us to) and they will not give us any information, let alone review the prior urine analysis, unless we pay $100+ for re-exams, plus the cost of another Urine Analysis and the cost of x-rays (that’s in addition to the $200 we've already spent going nowhere). 

 

Based on this information and the urine test results, what would you recommend is the best route to take at this time?  Any help you could provide would be so greatly appreciated. 

-----------------------------------------------------------------
REPLY FROM DR SING

Nov 1, 2014

I am Dr Sing Kong Yuen from Toa Payoh Vets. 
Are you from Singapore?
Each vet has his or her own way of diagnosis and treatment. However, diagnosis of urinary stones are best done on X-rays and/or ultrasound. Some urinary stones can be seen on X-rays. Were there any X-rays done by your vet who recommends surgery? If the guinea pig is "normal" now, it is best to wait and see. 

Ethics?

October 30, 2014

Today, an old client told me that she had received vaccination reminder card from a lady vet who was employed by me some 2 years ago. She commented that this vet was unethical and she would not go to consult her.

Is this practice ethical? There was a bank case in which the employee joined another bank and took the employer's list of clients to contact them. This employee was sued in court.

Employee vets will continue to use the employer's list of clients before they set up their own practice.     

Singapore stories. Mr Han goes to Phuket

Oct 30, 2014

Mr Han goes to Phuket today. His boss Joe asked me to a farewell breakfast at the usual food court. Mr Han had his laksa while Joe, for the first time, order beef ball and fish ball soup noodles. "I have never seen you order this dish," Mr Han commented. "Usually it is laksa and you drink all the gravy!"
I ordered the chee chiong fun with sesame seed and sweet sauce at $1.60.

I thought yesterday's breakfast was the last till Mr Han comes back from Phuket on Tuesday. As he had to go for his routine blood test for diabetes yesterday, he did not eat breakfast and was grouchy. He was at the food court and dozed off. The hawker lady from China, selling laksa, came to the table and curled her right index finger, indicating that Mr Han must have passed away. This was her sense of humour learnt from Joe.

After the breakfast today, Joe said I should take a photo of Mr Han as the "last" image.. In case his plane crashed. "It is best not to say such things," I tried to educate Joe who has this type of humour.
Yesterday Joe was on the same topic of plane crash and asked Mr Han to visit him after the crash and let him know he had come from heaven or hell. "Is there such a place as heaven or hell?" Joe asked.

"There is a supernatural but you need to encounter to believe," I narrated a story of my client who asked me to help her design a logo. Blood spots appeared on the table and draft logo papers when the design was not satisfactory to "datuk". A Caucasian employee had brought in a draft logo on his own initiative and designed by somebody while I was in the room. Blood spots appeared in this draft logo paper. Finally, there was a draft logo design done by me and the client with no appearance of blood and this would be deemed approved.  

"I am more the scientific-evidence type and this encounter would be hard for anyone to believe," I said to the two senior citizens. "I don't believe if I have not witnessed this event."

Anaesthetic risk in dental scaling A 7-year-old Sheltie with bad breath

Oct 28, 2014


A new client - father and young adult daughter brought in a 7-year-old male entire Shetland for dental scaling.  Their friend's Maltese had died after dental scaling in another vet practice and so they did not want to go to the practice.

"Very rarely do dogs die after waking up from anaesthesia given for dental scaling," I said. "Was the Maltese having heart diseases?"  The owners of the gentle full sized Sheltie did not know but they would avoid this friend's vet

No vet can guarantee no anaesthetic risk. Even people do die.

PHYSICAL EXAMINATION
Other than periodontal disease grade 4 (tissue attachment loss over 50%), I noted that this Sheltie had congested maroon red gums, not the normal pink ones. You can see this in the video. Why? The capillary refill time was longer than the usual 2 seconds. Blood test showed that this dog had a higher than normal amount of haemoglobin in his blood at 19.1 (12-18).  The total red cell count was normal. The haematocrit was normal too.  Platelets were normal. What does it mean? Was he fed some supplements?


BLOOD TEST on 27.10.14  Abnormal values

Urea 12.3  (4.2 - 6.3)
Creatiine 65  (89-177)
Haemoglobin 19.1 (12-18)

All the other blood values within normal limits.

 

Sedation was 50% of normal dog. Isoflurane gas to minimal amount.




FOLLOW UP - Day 2 after dental scaling
The dog was a bit tired yesterday but is Ok and eating today.

"Tartar started to build up fast in last 3 years," the father said that the dog was not given meat. "Could it be the milk making the kibbles soft?". This dog had the biggest crusty tartar I had ever seen in a dog (see image/video).

The dry dog food was  Science Diet Lamb and Rice with a brand of dog's milk since young. Dog treats were given.


ADVICES
No milk and treats to prevent tartar build up.
Eat dry food without milk and drink water.
Blood test 4 weeks later to check on the urea levels.

This case shows that a blood test is important for screening the health of an older dog. The owner was given the option. The blood test was done by me as this dog had an unusual congested gums.

----------------------------------------------------------------------------------
VIDEO

Oct 28, 2014.  A father and young adult daughter presented this gentle 7-year-old male Sheltie for dental scaling. A friend's Maltese had died after dental scaling by another vet and so the owners were worried about anaesthetic death. "Dogs usually do not die under anaesthesia or after anaesthesia," I said to the father. "Unless the dog has heart disease or poor health."
A thorough physical examination showed that this Sheltie with bad breath was generally healthy in heart and lungs. The heart beats were irregular. 50% sedation  of domitor and ketamine IV calmed this nervous Sheltie.
In this case, I gave an IV drip, with IV baytril, frusemide and Vit B complex.  
It is very important to provide a very close monitoring of the maintenance of isoflurane gas at 0-2%, oxygen flow rate at 2 litres/minute to ensure that minimal anaesthesia is being given. The dog did wake up in the midst of dental scaling as the maintenance dose was 0.5%. He was intubated again and maintained at 2%. The dog woke up fast and went home 3 hours later.  Follow up 2 days later showed that the dog is OK. The dog had been given dry dog food and milk since young. He likes only certain brands of milk. Well beloved family dog and in excellent body condition.