Sunday, January 25, 2015

1178. Rats

Jan 24, 2015

There is a restaurant at the back of the clinic. Rats were multiplying and the pest control people had come to eliminate the rats. Some even come to the back of the clinic. I hid away all the dry dog food and got the rat glue. There was an electrical short-circuit to the left side of the clinic, probably due to the exposed wires from the rat gnawing the wires above the ceiling.

According to the restaurant operator behind, the mother rat avoided or did not get stuck in the glue. Just ate the food and disappeared again. Yunger rats were stuck in the glue. 

Singapore has more complaints of rats and rat burrows. As stray cats have been mostly removed from the neighbourhoods, rats have thrived. More  business for pest controllers nowadays.

1177. A Schnauzer ate a big bar of Toberlone chocolates

Saturday Jan 24, 2015

Home dogs cannot talk but they are opportunistic. This Schnauzer saw two bars of the Swiss chocolate Toberlone and quickly swallowed one bar and a bit of the other before the owner spotted him. That was around 2 hours ago.

"The maid had put salt into his mouth but he would not vomit out the chocolates," the young lady said.

"Salt is a natural way to induce vomiting," I tried to place some salt on my forefinger and stick it at the back of his tongue as my assistant opened his mouth. No vomitng. I tried again another 3 times. Nothing happened. I had syringed in 2 ml of water and he had swallowed. But no vomiting. The dog must be salty by now. .

"Isn't there an injection to make him vomit?" the lady asked.
"Salt does work and is the natural way as compared to an injection."

After 10 minutes of no vomiting, I gave this dog 0.6 ml of 2% xylazine IM.  Xylazine injections often induces vomting depending on the dosage and sometimes it does not work.  

I asked Intern Ng to continue with her own work as I placed the dog inside the kennel. Within 5 minutes he vomited out all the melted chocolate and water. Evidence is there. We were all very happy

I gave the dog an IV drip to flush out any chocolate products inside the blood. The dog went home to a happy family. No food for one day to let the stomach settle down.
.

1176. A female Pom pees blood - bladder stones

Sunday Jan 24, 2015

To lower medical costs, X-rays need not be done if the stones are palpable and the owner had given informed consent.

A vet referred this young couple to 3 vet practices for X-rays and prescribed antibiotics. The wife came to Toa Payoh Vets for further consultation. 

I palpated the abdomen, felt crepitus (gas rubbing against stones) and could feel two smooth stones about 2 cm x 2 cm in addition to smaller ones. Surgery will prove whether I am correct.

Surgery scheduled 3 days later with the dog on antibiotics. Chances of survival are good as the dog is younger, her heart and lungs OK and eating," I said."The blood test will show us the health of the liver and kidneys."

The stones need to be analysed to confirm

Tuesday, January 20, 2015

Cases of stray cat caregives in Singapore











1. 2010. Stray cat with halithosis and mouth ulcers.
Vet 1 presumed FIV
http://www.toapayohvets.com/20120415feline-eosinophilic-mouth-ulcers-young-stray-cat-singapore-ToaPayohVets.htm

ECG? Eosinophilic Granuloma Complex, not FIV (test kit)


2. 2010. A young couple sends in 2 stray cats for spaying

 http://2010vets.blogspot.sg/2010/12/two-stray-cats-caterwaul-spay-nursing.html



3. FIV+ve, URTI and periodonitis in an adult stray cat
http://www.sinpets.com/F5/20111021stray-cat-runny-nose-drooling-FIV-singapore-toapayohvets.htm


4. HDB policy of cats in flats.

http://www.asiahomes.com/0737HDB_cats_Singapore.htm

In 2002, CWS has a proposal, please visit our website at
www.catwelfare.org 


5. 2001. 2 cases. The stray cat has rodent ulcers. The young unvaccinated cat has tongue ulcers

http://www.asiahomes.com/singaporetpvet/cats/9503Cat_eosinophilic_granuloma.htm



6. Promoting the adoption of stray cats from CWS
http://www.toapayohvets.com/sinpets/20120615digital_photography_stray_cat_adoption_singapore-ToaPayohVets.htm


7.  A stray cat activist

http://2010vets.blogspot.sg/2013/08/1101-stray-cat-activism-soft-masses.html




8. A stray cat swallows a fish bone
http://www.asiahomes.com/singaporehouses/000704cat_fishbone_palate.htm



9. 2003 The Singapore stray cats' days are numbered.
http://www.asiahomes.com/singaporetpvet/cats/030630stray_cats_culling_Singapore.htm




10. Spaying and neutering stray cats in Singapore
http://www.bekindtopets.com/animals/20090644Stray_Cats_Singapore_ToaPayohVets.htm



11. Stray dogs and cats in Istanbul's tourist area. Can Singapore do that?
http://2010vets.blogspot.sg/2013/12/1271-travel-stories-istanbuls-kindness.html



12. Dental problems in the older Singapore cat
http://www.toapayohvets.com/surgery/20091166periodontal_disease_cat_ToaPayohVets.htm


13. Stray cat for adoption in social media FLICKR
https://www.flickr.com/search/?q=cats&w=33995662%40N00


http://www.asiahomes.com/singaporetpvet/tips/toa_payoh_vets_links.htm

14.  2015. A stray cat has no appetite or meow for 4 days
https://www.youtube.com/watch?v=gNj5wNug4zE&feature=youtu.be


15. Spaying caterwauling cats
http://www.bekindtopets.com/animals/20090637Spaying_Caterwauling_Cats_Dr_Sing_Singapore_ToaPayohVets.htm

16.2002. The cat has a loose tongue
http://www.asiahomes.com/singaporeaur/0716landlord_noresponse.htm

17. A fish bone stuck in the cat's throat
http://www.asiahomes.com/singaporetpvet/cats/000629cat_fishboneinthroat.htm


18. Stray cats in NANAS
http://www.bekindtopets.com/animals/20080427Shelter_Medicine_ToaPayohVets.htm


19.  A salivating stray cat has eosinophilia
http://www.sinpets.com/cats/20100641eosinophilia_stray_cat_singapore_ToaPayohVets.htm


20. Gingivitis and stomatitis in an old cat
http://www.sinpets.com/F5/20120231chinese-new-year-2nd-day-vet-cases-Singapore_ToaPayohVets.htm

21. Antagonising service providers - cat activists.
http://www.bekindtopets.com/animals/20080525Animal_Activism_ToaPayohVets.htm


22. Necrotic cat abscess in an old stray cat
http://www.asiahomes.com/singaporetpvet/cats/030132necrotic_abscess_cat_bite_Singapore.htm


23. 1997. fish bone, uterine prolapse in stray cat
http://www.asiahomes.com/singaporetpvet/cats/catcase_photo.htm


24. stray cat has flu
http://www.asiahomes.com/singaporetpvet/cats/1012cat_flu.htm

15. The malodorous cat
http://www.toapayohvets.com/surgery/20061010Malodorous_Cat.htm

16. spaying a bisexual cat
http://www.bekindtopets.com/cats/20080739Spay_Cat_Bisexual_ToaPayohVets.htm

17. Two vet students goes to rescue stray kittens for NANAS
http://www.sinpets.com/dogpix/20080177Raymund_Wee_NANAS_stray_kittens_ToaPayohVets.jpg
http://www.bekindtopets.com/animals/tpvets_Feb208.htm

28. Injectable anaesthetic for cats
http://www.sinpets.com/F5/20110332veterinary-anaesthesia-dogs-cats-rabbits-singapore-toapayohvets.htm



Friday, January 16, 2015

1174. Intern Ng. Rare uterine serosal inclusion cysts in a pyometra Golden Retriever


The Golden Retriever had profuse dark brown vaginal discharge - open pyometra diagnosed by the other vet on 12.1.15. Heat was 1 month ago. Vulval discharge 34 days. Vomited once  days ago.

X-rays and blood tests done. Advised immediate surgery as antibiotics may stop the discharge but this infection will recur. Costs would be $3,000. No more vaginal discharge at consltation in Toa Payoh Vets on 14.1.15

"As the life span of a Golden Retriever is around 12 years and this dog is 13 years," I told Dr Daniel who was discussing about alternative medical treatment to surgery. "The owner was thinking of euthanasia rather than take the anaesthetic risk of surgery. The fees still have to be paid if the dog dies on the op table!"

Spaying the dog young would have prevented such anaesthetic worries and financial costs. The dog was given IV drips with amino acids and antibiotics overnight.  More dirty vaginal discharge passed overnight. Operated by Dr Daniel in the afternoon and went home in the evening. Low dosage of Domitor and Ketamine at 0.1 ml + 0.1 ml IV plus isoflurane gas.

"Only after 7 days do we know whether your dog is back to normal," I advised the couple. Surrpising, this case had a large number of uterine cysts, so rare that I had not seen in over 100 pyometra cases done over the last 30 years. This is the first case of uterine cysts seen by me. I don't know whether other vets have had seen such occurrences. Cystic endometrial hyperplasia is part of the pyometra disease but such cysts are usually inside the uterus.


CHANCES OF SURVIVAL FROM ANAESTHESIA AND SURGERY
1. Age. 13 years old - very old for a Golden Retriever.
2. Kidney impairment. Vomited once only.
3. Duration of illness. Vaginal discharge said to be for 3 days.
4. Health is poor - Lethargic. Not standing or eating.
Blood test showed bacterial infection and blood loss. No kidney impairment. Abnormal values are:

  RBC 5.1   (5.5-8.5).
  Hb    14.3 (12-18)
  PLT   556 (175-500)

WBC  22.8  (5.5-17)|
NEU  14.8  (2-12)
MONO  3.8 (0.3-2)
EOS  2.2  (0.1 - 1.5)

Peripheral blood smear - normocytic normochromic erythrocytes. Adequate platelets.
Leucocytosis with neutrophila. Babesia negative

3. Anaesthesia. Isoflurane gas is best.  In this case, very low dose of Domitor 0.1 ml + Ketamine 0.1 ml IV was given before maintenance with gas. I noted that the dog was still drowsy post op. For old dogs, it is best not to wait for her to recover. Antisedan 0.1 ml reversed the domitor sedation and the dog was alert after 15 minutes. Went home in the evening.

4. Follow up 16.1.14  10.15 am, 19 hours post-operation.  Owner said the dog was very weak and would not go to the bathroom by herself. She ate a bit and he had to syringe feed her. I advised feeding 6 X/day. 

5. The first vet had prescribed Clavet 500 mg 1 tab bid and Tramadol 50 mg 1.5 tablets bid

VIDEO



FOLLOW UP ON DAY 7 AFTER SURGERY.   Jan 20, 2015 5 pm. Managed to reach the husband by phone. I was expecting the worst as the dog was so thin and was unable to stand up and ate less on Day 2. Day 1 is surgery day on Jan 13, 2015.
"The dog does not need to be lifted up since yesterday," the husband had also said that the dog had passed bloody discharge after the pyometra surgery. "For the past 6 days, she could not stand up."

I was glad to know that the dog had recuperated well. She ate more and drank normal amounts. Her stools and urine were normal.

"She is so thin that I was worried that she would pass away," I told Intern Ng. "Since she can survive 7 days and is walking by herself, she will likely live."

The first 7 days are critical. I had phoned the owner to tell him that the dog must be fed 3 times a day, instead of once. She has poor appetite and so should be fed more times.  I also gave the owner a high energy vitamin supplement to be given a tablespoon a day and he had asked to buy another tube.

MAKING A VIDEO. These are the pointers I gave to Intern Ng. Whether she can create a good movie of this ordinary pyometra case, depends on her ability. There are at least 5 conflicts.

1. Old dog likely to die under anaesthesia.
2. Thin old dogs have higher risks. They may die after surgery within the first 7 days.
3. Medical and surgical costs over $3000 as quoted by the first vet. So, is it more pragmatic to euthanase the dog since the money spent still has to be paid even if she dies on the op table? This was considered.
4. Reputational risk of the vet. Why operate high risk dogs and risk ruining his reputation?
5. Experience of vet. Immediate surgery advised by first vet. I would not advise it. Stabilise the dog first. The dog had 2 days of antibiotics and this eliminated the bacteria and enhance her chances of survival. 3 bottles of drip. 2 before and 1 after surgery.

 
     

Friday, January 9, 2015

A different approach to cat spay - head downwards 45 degrees

https://www.youtube.com/watch?v=4I1wMYQU3k8

Video:
Cat spayed in upside down position.


https://www.youtube.com/watch?v=4I1wMYQU3k8
This slanting  head downwards position is said to be easier access to the ovaries and a quicker spay.

Video:
Cat spayed in upside down position.

1. The vet ligates the ovarian blood vessels separate from the uterine horns and and then cut it off. The ovary and uterine horns are clamped.  Traditionally, the vet ligates the combined ovarian blood vessels and uterine horns.


2. The vet clamps the uterine body. He ligates the uterine body cranial to the clamp. Then he cuts off the uterine body cranial to the ligation.

3. Injectable anaesthesia IM is used. Long recovery period.

Thursday, January 8, 2015

1172. An 11-year-old Shih Tzu passes blood in the urine again

Jan 8, 2015
Two dry eyes, right eye has irritating upper eyelid conjunctival growths. Passing blood in the urine for the past years. Generalised skin diseases.


 






"My dog had passed blood in the urine but had recovered," the lady owner said. "Now, he dribbles blood in the urine again!"

The dog peed fresh blood on the mat of the weighing machine. He weighs 9.3 kg and has dry eyes as well as a row of right upper eyelid tumours. He had a very itchy body and a painful right ear.
"Shih Tzus need regular grooming and are high maintenance dogs." I said to the owner.

I placed him on the consultation table and palpated his abdomen. There was a golf-ball sized lump in his bladder area. No pain. It was lower down and could also be an enlarged prostate since he had haematuria and dribbling of urine.



X-rays. It is important to have 2 views. The V/D view shows gas inside the almost empty bladder while the lateral view showed an opaque bladder.

So, is it a bladder neoplasia or chronic cystitis? There appeared to be no radio-dense bladder stones
but in a previous urine test done several weeks ago, there was calcium oxalate crystals in the urine.

The eyelid conjuntival growths on the right eye were electro-excised by Dr Daniel and medication for the generalised skin infections were prescribed. The bladder was empty and no urine could be collected. Antibiotics cleared the bladder infections as no blood was passed in the urine on follow up 2 days later.

CONCLUSION
Based on the clear contrast of the ventral-dorsal X-ray showing the thickened bladder wall and air, this is likely to be a chronic cystitis rather than a bladder tumour. Some bladder stones are not radio-dense and hence not visible on X-rays. The prostate enlargement may not be large and is not visible on X-ray. An ultrasound of the prostate to check for prostatic cysts or abscesses cannot be done owing to the need to reduce medical costs.  

A urine test is needed but no urine was available when the dog's bladder was catheterised. The owner wanted only the eyelid tumours to be removed. Electro-excision  was done by Dr Daniel.