Wednesday, December 10, 2014
Tuesday, December 9, 2014
1131. Perineal urethostomy in the male neutered cat
Dr Tun Thein Aung from Royal Asia Veterinary Surgery visited me today and explained how he performed the perineal urethrostomy in the male cat.
Basically,
1. Dissect between the anus and penis, taking care not to cut the anal area. Lots of fat. No bleeding.
2. Blunt dissection of the area to expose the roots of the penis and further below 2 muscle bands. These muscle bands are below the roots and must be used to stitch up the opened urethra after penile amputation.
3. Catheterise and elevate the penis high up.
4. Use scalpel to incise urethra at most ventral point (larger diameter). Take out the catheter and use eye scissors to cut the urethra towards the muscle bands.
5. Amputate the penis.
6. Suture skin edges after amputation dorsally lateral to lateral.
7. Stitch urethral opening to the lower and side of the muscle bands.
Cat no longer suffers from dysuria. An easy operation, he said.
An Australian CD of the op is available.
Basically,
1. Dissect between the anus and penis, taking care not to cut the anal area. Lots of fat. No bleeding.
2. Blunt dissection of the area to expose the roots of the penis and further below 2 muscle bands. These muscle bands are below the roots and must be used to stitch up the opened urethra after penile amputation.
3. Catheterise and elevate the penis high up.
4. Use scalpel to incise urethra at most ventral point (larger diameter). Take out the catheter and use eye scissors to cut the urethra towards the muscle bands.
5. Amputate the penis.
6. Suture skin edges after amputation dorsally lateral to lateral.
7. Stitch urethral opening to the lower and side of the muscle bands.
Cat no longer suffers from dysuria. An easy operation, he said.
An Australian CD of the op is available.
1130. Threshold of death. A 14-year-old Maltipoo cannot breathe - a gigantic right submandibular abscess
2nd case within 2 weeks of a large submandibular swelling in the dog.
The other dog with similar swelling on the submandibular had no pain and a cytology revealed cyst.
In this 14-year-old male maltipoo, he was not eating for one day. Panting and breathless.
Bad breath. Drooling on right side of cheek. Large swelling 6" x 3" extending below neck. Very painful.T=39.4C. What's wrong?
X-ray of this maltipoo on first consultation on Dec 9, 2014
M 0.1% Absolute 0.07
E 0.3% Absolute 0.21
B 0%
HISTOLOGY report from 2 biopsy punches on side of submandibular swelling.
URINE TEST
pH 6.5 SG 1.030. Protein 2+. Blood trace. Bacteria 3+. White blood cells 288. Red blood cells 18. Epithelial cells 38. Suspect UTI
Fortunately he recovered and the owner was happy to see him alive. He went home in the evening with medication.
FOLLOW UP
"The dog is breathing better than yesterday," the wife said.."He eats a little egg yolk and meat and drinks water by himself."
"Any stools passed?" I asked.
"No."
M 5% Absolute 2.3
E 0% Absolute 0
B 0%
Dog is active, not breathless. Eat, drinks and pees a lot. Advised resting, no serious exercise
FOLLOW UP ON JAN 5, 2015 at 3.45 pm
I first saw the breathlessness and painful right submandibular swelling, measuring 6" X 3" on Dec 9, 2014. Today is nearly one month later. The dog came in for a check up. No more swelling at all.
All are well with his appetite and drinking, peeing and pooping. He has the occasional coughing after eating. I advised dental scaling today, as the bad breath would return after all these antibiotic mediation.
The ears are no longer infected as the ear drop medication was applied. The dog actually put on weight and today, is 10.1 kg compared to 9.7 kg on Dec 9, 2014.
CONCLUSION
The bacteria would be from the chronic ear infection of the past 6 months. The owner went to a vet who prescribed medication but the pus kept coming out from the ear. The owner did not seek further treatment. Then the dog became inactive and the next day, developed a right submandibular swelling. He could not breathe normally. The owners decided to come to Toa Payoh Vets.
This case is most likely a bacteria infection from the vertical canal going into the side of the ear and downwards. This bacteria was very fast growing and the 14-year-old dog's immune system could not fight it. Neutrophils went up to 98% (normally 60-70%) and the total white cell count shot up sky high.
I searched google and there is a similar submandibular swelling from a chronic ear abscess in another country. Another vet had operated but the pus persisted. Foreign body or tumour was suspected to be the cause of this pus which kept coming out of the ear as in my case. The bacteria cultured was psuedomonas. The case is at:
https://www.youtube.com/watch?v=OtjgriWDqCE
TIP. The owner should not let ear infections esp. with pus linger on for months without seeking a second opinion from another vet.
The other dog with similar swelling on the submandibular had no pain and a cytology revealed cyst.
In this 14-year-old male maltipoo, he was not eating for one day. Panting and breathless.
Bad breath. Drooling on right side of cheek. Large swelling 6" x 3" extending below neck. Very painful.T=39.4C. What's wrong?
X-ray of this maltipoo on first consultation on Dec 9, 2014
BLOOD TEST
Dec 9, 2014
Abnormal
Total white cell count 68.5 (6-17)
N 98% (60-70%) N absolute 67.13 (3-11)
L 1.6% L Absolute 1.10M 0.1% Absolute 0.07
E 0.3% Absolute 0.21
B 0%
Platelets 142 (200-500).
Several abnormal lecuocytes seen. Occasional nucleated red blood cells seen. Large platelets present.
No malignancy
URINE TEST
pH 6.5 SG 1.030. Protein 2+. Blood trace. Bacteria 3+. White blood cells 288. Red blood cells 18. Epithelial cells 38. Suspect UTI
During the IV drip on Dec 9, 2014, the dog with breathing difficulty started barking in response to another Spitz barking. Suddenly he collapsed with cyantoic tongue. This was surprising. I quickly punched his chest on the spot and massage vigorously, to stimulate the heart beat. I pulled his tongue out with forceps so that he could breathe. There was no time to waste as he was in the throes of death.
Fortunately he recovered and the owner was happy to see him alive. He went home in the evening with medication.
FOLLOW UP
on Dec 10, 2014, 10 am, I phoned the owner to discuss the blood test report and the possibility of a severe bacterial infection of the throat area.
"The dog is breathing better than yesterday," the wife said.."He eats a little egg yolk and meat and drinks water by himself."
"Any stools passed?" I asked.
"No."
I got another blood test done on Dec 15, 2014
BLOOD TEST
Dec 15, 2014
Abnormal
Total white cell count 45.1 (6-17)
N 86% (60-70%) N absolute 39 (3-11)
L 9% L Absolute 4.1M 5% Absolute 2.3
E 0% Absolute 0
B 0%
Platelets 135 (200-500).
No platelet clumps seen.
Liver disorder this 2nd test. Hepatitis.
SGPT/ALT 424 (below 59) SGOT/AST 106 (below 81)
FOLLOW UP on Dec 19, 2014 9.47 am
Dog is active, not breathless. Eat, drinks and pees a lot. Advised resting, no serious exercise
FOLLOW UP ON JAN 5, 2015 at 3.45 pm
I first saw the breathlessness and painful right submandibular swelling, measuring 6" X 3" on Dec 9, 2014. Today is nearly one month later. The dog came in for a check up. No more swelling at all.
All are well with his appetite and drinking, peeing and pooping. He has the occasional coughing after eating. I advised dental scaling today, as the bad breath would return after all these antibiotic mediation.
The ears are no longer infected as the ear drop medication was applied. The dog actually put on weight and today, is 10.1 kg compared to 9.7 kg on Dec 9, 2014.
CONCLUSION
The bacteria would be from the chronic ear infection of the past 6 months. The owner went to a vet who prescribed medication but the pus kept coming out from the ear. The owner did not seek further treatment. Then the dog became inactive and the next day, developed a right submandibular swelling. He could not breathe normally. The owners decided to come to Toa Payoh Vets.
This case is most likely a bacteria infection from the vertical canal going into the side of the ear and downwards. This bacteria was very fast growing and the 14-year-old dog's immune system could not fight it. Neutrophils went up to 98% (normally 60-70%) and the total white cell count shot up sky high.
I searched google and there is a similar submandibular swelling from a chronic ear abscess in another country. Another vet had operated but the pus persisted. Foreign body or tumour was suspected to be the cause of this pus which kept coming out of the ear as in my case. The bacteria cultured was psuedomonas. The case is at:
https://www.youtube.com/watch?v=OtjgriWDqCE
TIP. The owner should not let ear infections esp. with pus linger on for months without seeking a second opinion from another vet.
1129. Script for RGS Intern. No excuses - The old Shih Tzu had big bladder stones
Dec 9, 2014
HOOK
The Shih Tzu has blood in the urine some days and "none" on other days for the past 4 years. What is the big deal? He could still eat his home-cooked food. Some dry food on stand-by. He goes to the newspapers to pee. On Dec 8, 2014, the dog stopped eating and vomited 3 times.
INTRODUCTION
Dr Daniel took the blood test and got the dog's abdomen X-rayed as he palpated bladder stones. His blood showed hepatitis and a high serum urea. The dog was given the I/V drip and was warded. He passed away in his sleep at around 9.30 am the next day.
"Why did my dog die?" the husband asked me. His wife was grief-stricken. "Is it due to the I/V drip?"
MIDDLE
"No," I had the blood test evidence of hepatitis and high serum urea. "The dog was not well as he had vomiting. Vomiting is not a good sign in dogs with long-standing urinary stones inside the bladder. The 6 stones are large as you can see from the X-rays and must have caused bladder irritation and urinary tract infection over the past 4 years. Did the dog vomit during the past 4 years?
"Yes, yellow vomitus now and then," the husband recalled. "Do dogs not vomit now and then?"
"No," I said. "Unless they are not healthy. With blood in the urine, your dog could have suffered from urinary tract infections and hence vomiting."
FLASH BACK (VIDEO OF SHIH TZU PUPPY)
I knew this male Shih Tzu as a puppy some 10 years ago. Gave him his puppy vaccination. A young couple with no children. The tricolour grew up and I have grown to become elderly.
The couple brought the Shih Tzu in for vaccination in 2013 and Dr Daniel gave him the jabs.
"Did Dr Daniel advise you to treat for blood in the urine?" I asked the husband. as I reviewed the medical records with a heavy heart. This dog was such a lovely tricolour puppy and now he had died.
after vomiting 3 X yesterday. Vomiting is not a good sign for an old dog.
The owner had switched to home-cooked food in the past years. "Whenever he ate dry food, he passed blood in the urine," the husband told me when I asked him yesterday whether the dog had urine, blood tests or X-rays done by another vet. He did not consult other vets although he lived
"far away" from Toa Payoh. There was a vet clinic in his neighbourhood. Presently, Singapore has over 60 veterinary clinics satisfying the proximity and convenience for the Singaporean pet owners.
DEATH CERTIFICATE AND GRIEVING WIFE
I issued a death certificate today as the husband phoned me for one, to cancel his dog licensing by the authoritiies. "I cannot understand why you did not do further tests to remove the bladder stones last year when Dr Daniel advised you," I asked him. "This dog could have lived to a ripe old age. I mean you are not like those lowly educated Singapoean dog owners who would only feed the dog despite old rotten decayed teeth and bad breath. They would let the teeth drop off and would not seek veterinary treatment."
His wife was badly affected by the death as women are closer to the companion than men, generally
I was most saddened by this loss as this was a puppy I had vaccinated over the earlier years. There was no complaint about blood in the urine which was present some 5 years ago. I advised against immediate bladder stone removal surgery as the dog was not eating and was vomiting. Otherwise, he would have had died on the operation table as he was such a high risk candidate for anaesthesia and surgery..
Dr Daniel advised blood tests and X-rays yesterday and there were around 6 big bladder stones. But vomiting was what brought the dog here yesterday.
X RAYS
VIDEO OF DR SING'S REMARKS ON X-RAYS
Conclusion
Regular blood and urine tests after the age of 7 years for small breeds and 5 years for big breeds are advised. X-rays must be taken when there is blood in the urine but most Singapore dog owners do not do it.
HOOK
The Shih Tzu has blood in the urine some days and "none" on other days for the past 4 years. What is the big deal? He could still eat his home-cooked food. Some dry food on stand-by. He goes to the newspapers to pee. On Dec 8, 2014, the dog stopped eating and vomited 3 times.
INTRODUCTION
Dr Daniel took the blood test and got the dog's abdomen X-rayed as he palpated bladder stones. His blood showed hepatitis and a high serum urea. The dog was given the I/V drip and was warded. He passed away in his sleep at around 9.30 am the next day.
"Why did my dog die?" the husband asked me. His wife was grief-stricken. "Is it due to the I/V drip?"
MIDDLE
"No," I had the blood test evidence of hepatitis and high serum urea. "The dog was not well as he had vomiting. Vomiting is not a good sign in dogs with long-standing urinary stones inside the bladder. The 6 stones are large as you can see from the X-rays and must have caused bladder irritation and urinary tract infection over the past 4 years. Did the dog vomit during the past 4 years?
"Yes, yellow vomitus now and then," the husband recalled. "Do dogs not vomit now and then?"
"No," I said. "Unless they are not healthy. With blood in the urine, your dog could have suffered from urinary tract infections and hence vomiting."
FLASH BACK (VIDEO OF SHIH TZU PUPPY)
I knew this male Shih Tzu as a puppy some 10 years ago. Gave him his puppy vaccination. A young couple with no children. The tricolour grew up and I have grown to become elderly.
The couple brought the Shih Tzu in for vaccination in 2013 and Dr Daniel gave him the jabs.
"Did Dr Daniel advise you to treat for blood in the urine?" I asked the husband. as I reviewed the medical records with a heavy heart. This dog was such a lovely tricolour puppy and now he had died.
after vomiting 3 X yesterday. Vomiting is not a good sign for an old dog.
The owner had switched to home-cooked food in the past years. "Whenever he ate dry food, he passed blood in the urine," the husband told me when I asked him yesterday whether the dog had urine, blood tests or X-rays done by another vet. He did not consult other vets although he lived
"far away" from Toa Payoh. There was a vet clinic in his neighbourhood. Presently, Singapore has over 60 veterinary clinics satisfying the proximity and convenience for the Singaporean pet owners.
DEATH CERTIFICATE AND GRIEVING WIFE
I issued a death certificate today as the husband phoned me for one, to cancel his dog licensing by the authoritiies. "I cannot understand why you did not do further tests to remove the bladder stones last year when Dr Daniel advised you," I asked him. "This dog could have lived to a ripe old age. I mean you are not like those lowly educated Singapoean dog owners who would only feed the dog despite old rotten decayed teeth and bad breath. They would let the teeth drop off and would not seek veterinary treatment."
His wife was badly affected by the death as women are closer to the companion than men, generally
I was most saddened by this loss as this was a puppy I had vaccinated over the earlier years. There was no complaint about blood in the urine which was present some 5 years ago. I advised against immediate bladder stone removal surgery as the dog was not eating and was vomiting. Otherwise, he would have had died on the operation table as he was such a high risk candidate for anaesthesia and surgery..
Dr Daniel advised blood tests and X-rays yesterday and there were around 6 big bladder stones. But vomiting was what brought the dog here yesterday.
X RAYS
VIDEO OF DR SING'S REMARKS ON X-RAYS
Conclusion
Regular blood and urine tests after the age of 7 years for small breeds and 5 years for big breeds are advised. X-rays must be taken when there is blood in the urine but most Singapore dog owners do not do it.
1128. No more urinary tract infection for this retiree's cat
A few male cats suffer from urinary tract infection. The retiree used to come for antibiotics whenever his home cat suffers from UTI. One day, last year, I advised him to feed the cat the prescription diet C/D, canned and dry to acidify the cat's urine and so prevent bacterial infection.
He tried this method and the outcome was excellent as his home cat no longer suffers from painful urination and has not come for antibiotics.
Many UTI cat owners in Singapore have no patience to switch the cat to a new diet and spent much medical costs on the treatment of recurring UTI in male neutered cats. Some cats were put to sleep as the owners could not afford the veterinary fees.
The over 70-year-old man showed me a video of a limping stray cat he felt sorry for. He would not bring it for diagnosis. I prescribed some tolfedine for this cat and he would let me know the outcome.
Monday, December 8, 2014
$10,000 for a young lady
Dec 8, 2014
I find it hard to believe that this 64-year-old grandma was sold for $10,000 when she was 17 years old. "I still keep the receipt," she said to me.
Her mum married a man 20 years her senior. She had 10 children - 7 girls and 3 boys. She was the 3rd child. There was never sufficient money to feed so many.
"One day, my brother said that a tree branches had fallen and obstructed the entrance to the pig pen," she related this story. "My father chopped the tree down. Instead of chopping the trunk nearer to him, he chopped the other side. The tree fell onto the roof of the pig pen. His mouth was slashed and he became giddy and fainted one week later. When the doctor said he needed an operation to remove the blood clot in his brain, he ran away from the hospital. Another 2 weeks later, he fainted and was operated."
"Did he survive?" I asked.
"Yes, he did but was never the same again as he could not work much. Lying around the house. My mum was forced to go out to work to feed him and the 10 children."
"What did she do?" I asked.
"She was a pig middle man, earning $0.50 to $1.00 per pig sold to the butcher. At that time, 0.15 cents could buy you a bowl of noodles and so this amount was big. Nowadays, children would not even pick up a $1.00 coin on the road!"
"Did you go to high school?" I asked.
"No, my family was living hand to mouth every day. I stopped studying at Sec 2 to help my family. I had to shoulder the porker (6 months) with my father to sell it at the market!"
That would be before 1967 as she was 17 years old and sold to the butcher.
"My mum was pestered for payment as Chinese New Year was near. The builder of the pig pens had supplied sand and concrete and had agreed to receive payment when the piglets were sold but he came early and pestered for money."
"Pigs can only be sold at 6 months of age," I remembered my veterinary work as a government vet in the PPD Extension Centres when I started work in 1977 after National Service.
"You know this arrangement?" she was surprised.
"Yes, I was in this government service and there were a few small pig farms then.
"The government took back the farm land," she said. "They just leased the land to us and paid us some money,"
"Yes, yes. For every standing tree you had planted, the government would pay accordingly". This was the era that the younger generation was never aware. The farmers had political clout in the early years before 1967. "
"How many children did you bear from this butcher?" I asked. "Was he married?"
"I had 2 children. I told him I would leave him after 10 years. He was married but he was also a womaniser."
"Why didn't you not marry him?" I asked.
"I was a country pumpkin and knew nothing of the world. My mother had to clear the debts and the $10,000 would pay the builder and other debts. The butcher promised to settle all her outstanding debts."
"Was there a wedding? I asked.
"No, no. A sales and purchase agreement. I still retain the copy."
"It is a surprise that you stayed with him for 10 years."
"Did your children give you money?" I asked since both daughters were house-wives.
"My younger daughter gets her husband to give me $300. But I save the money for her." She was still working as a bus driver and so was heavily made up like an opera singer. This was a fashion in the old days for women.
Her mobile phone was clicking and clicking while I examined the poodle puppy that had sore throat after attempting to swallow a button. This was her daughter's puppy and she was the caregiver as the daughter was in Korea on holiday.
"The puppy's throat is painful on palpation," I showed the gagging sound. "You better answer your phone."
"Oh, those are pictures from my daughter in Korea. Young people will send every item of food they eat in the restaurant to me!"
"You are a lucky mum," I said. "Your daughter sends you such pics. Some children going overseas on holidays rarely remember their parents at home, let alone send any pics. The puppy should be OK but an X-ray would be needed if you want one."
She decided to wait. She cared for a stray cat last week and had it spayed. That was when I first met her. Her grandson adopted the spayed cat.
I find it hard to believe that this 64-year-old grandma was sold for $10,000 when she was 17 years old. "I still keep the receipt," she said to me.
Her mum married a man 20 years her senior. She had 10 children - 7 girls and 3 boys. She was the 3rd child. There was never sufficient money to feed so many.
"One day, my brother said that a tree branches had fallen and obstructed the entrance to the pig pen," she related this story. "My father chopped the tree down. Instead of chopping the trunk nearer to him, he chopped the other side. The tree fell onto the roof of the pig pen. His mouth was slashed and he became giddy and fainted one week later. When the doctor said he needed an operation to remove the blood clot in his brain, he ran away from the hospital. Another 2 weeks later, he fainted and was operated."
"Did he survive?" I asked.
"Yes, he did but was never the same again as he could not work much. Lying around the house. My mum was forced to go out to work to feed him and the 10 children."
"What did she do?" I asked.
"She was a pig middle man, earning $0.50 to $1.00 per pig sold to the butcher. At that time, 0.15 cents could buy you a bowl of noodles and so this amount was big. Nowadays, children would not even pick up a $1.00 coin on the road!"
"Did you go to high school?" I asked.
"No, my family was living hand to mouth every day. I stopped studying at Sec 2 to help my family. I had to shoulder the porker (6 months) with my father to sell it at the market!"
That would be before 1967 as she was 17 years old and sold to the butcher.
"My mum was pestered for payment as Chinese New Year was near. The builder of the pig pens had supplied sand and concrete and had agreed to receive payment when the piglets were sold but he came early and pestered for money."
"Pigs can only be sold at 6 months of age," I remembered my veterinary work as a government vet in the PPD Extension Centres when I started work in 1977 after National Service.
"You know this arrangement?" she was surprised.
"Yes, I was in this government service and there were a few small pig farms then.
"The government took back the farm land," she said. "They just leased the land to us and paid us some money,"
"Yes, yes. For every standing tree you had planted, the government would pay accordingly". This was the era that the younger generation was never aware. The farmers had political clout in the early years before 1967. "
"How many children did you bear from this butcher?" I asked. "Was he married?"
"I had 2 children. I told him I would leave him after 10 years. He was married but he was also a womaniser."
"Why didn't you not marry him?" I asked.
"I was a country pumpkin and knew nothing of the world. My mother had to clear the debts and the $10,000 would pay the builder and other debts. The butcher promised to settle all her outstanding debts."
"Was there a wedding? I asked.
"No, no. A sales and purchase agreement. I still retain the copy."
"It is a surprise that you stayed with him for 10 years."
"Did your children give you money?" I asked since both daughters were house-wives.
"My younger daughter gets her husband to give me $300. But I save the money for her." She was still working as a bus driver and so was heavily made up like an opera singer. This was a fashion in the old days for women.
Her mobile phone was clicking and clicking while I examined the poodle puppy that had sore throat after attempting to swallow a button. This was her daughter's puppy and she was the caregiver as the daughter was in Korea on holiday.
"The puppy's throat is painful on palpation," I showed the gagging sound. "You better answer your phone."
"Oh, those are pictures from my daughter in Korea. Young people will send every item of food they eat in the restaurant to me!"
"You are a lucky mum," I said. "Your daughter sends you such pics. Some children going overseas on holidays rarely remember their parents at home, let alone send any pics. The puppy should be OK but an X-ray would be needed if you want one."
She decided to wait. She cared for a stray cat last week and had it spayed. That was when I first met her. Her grandson adopted the spayed cat.
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