Saturday, May 9, 2015

1188. Feline urethrostomy

https://www.youtube.com/watch?v=2KcuW-trvPI

Monday, May 4, 2015

1187. Kidney stones - Intense abdominal pain in an old poodle

Sunday May 3, 2015

The 12-year-old poodle is much loved. 2 years ago, she had a bladder stone removed. I advised that the few specks of stones in the left kidney can be dissolved by S/D diet. However, the owner did not come for reviews for the next 2 years as the dog was fed home-cooked food. The left kidney now has large stones.








Kidney stones do occur in dogs but are rare compared to bladder stones. In this case, the dog was free of blood in the urine for 2 years after removal of the large bladder stone. I had advised S/D diet to remove the few specks of stones in the left kidney (as seen in the X-ray).

I did not do hard sell as this may antagonise the owners.  The owner did not follow up after bladder stone removal for the next 2 years. Now the dog has acute abdominal pain and kidney failure. Singapore does not have the machine to break down the bladder stones using sound waves and in any case, it would be very expensive. The dog was in great pain and had kidney failure. No operation to remove the left kidney is advised as the dog would die on the op table.

In retrospect, if the owner agrees, the dog would be on S/D diet for 3 months. X-rays and urine test. 

Sunday, May 3, 2015

1186. The 13-year-old Beagle X has diarrhoea many times for the past 4 days

Sunday May 3, 2015

"His right eye has pus and is very red," the young man said. "He has diarrhoea 3-4 x/day for the past 4 days!"

The old Beagle had circum-anal tumour removed by Dr Daniel some 3 weeks ago. He did not come back for neutering as the male hormones could cause a recurrence of the circum-anal tumour.

"Could the tumour cause the diarrhoea?" the young man asked.

"It is possible if it is cancerous and has spread into the intestines," I said.

"I would like the tumour tested for cancer."

"It is too late as you did not want it tested after surgery as we don't keep it."

"What is the cause of diarrhoea?" the young man asked. "We feed the same dry dog food,"

"The dog was boarded earlier than 4 days ago and could have eaten other food upsetting his stomach. It could be viral infections from other dogs in the boarding house, causing gastro-enteritis."

The dog would be given IV drip, antibiotic and anti-diarrhoea for the next 24 hours.

1185. An investment banker's Schnauzer keeps scratching ears non-stop

Saturday May 2, 2015

"It is the cost of the ear surgery," the investment banker had not turned up for the surgery in 2014. The dog had frequent head shaking and ear scratching for the past 2 years. So he brought the dog in for treatment of ear irrigation and medication. I explained to him that the best solution would be to do ear surgery to open up the side wall of the ear canal. 

This Schnauzer has very hairy ear canals and so there was no drainage and ventilation. The continuous scratching and vet treatment over the last 2 years added up and would cost more than the surgery.

I showed him the video of a Schnauzer after ear surgery at:
  https://www.youtube.com/watch?v=tQKGWCS-mzo&feature=youtu.be

"The Schnauzer needs some maintenance of the horizontal ear canal when his ears feel itchy," I said to him. "But there will be much less scratching every time, causing ear swelling and pain."

An appointment for surgery is made on May 12, 2015 and this time, the banker intends to keep the appointment. It seems like a hard sell to advise ear surgery. It seems expensive at $900 for 2 years at this time, but I advise surgery when it is needed by the dog to save the dog many weeks of head shaking and ear scratching. In some cases, chronic otitis externa lead to infections of the middle ear and head tilt after the ear drum had ruptured and bacteria goes into the middle ear. It will be too late.      

Friday, May 1, 2015

1184. A hardy hamster

May 1, 2015

Two brothers in their early 20s brought in a hardy hamster on this bright morning of Labour Day. The hamster weighs 33 g and has two black ulcerated tumours. One below the chest at 2 cm x 2 cm and the other below the left armpit at 8 mm x 6 mm.

"Why didn't you get the tumour removed when it is small?" I asked.

"We asked a vet and he said to leave it alone," the elder brother said that the tumours were present for around 2 months and could be cancerous. As the hamster exercised, the lower part of the tumour got worn out and became infected and now blackened.

I checked the thin hamster's teeth. He had short teeth indicating that he was still eating to survive.
"He had lost a lot of weight," I said. "He does eat judging by his short front teeth being worn out, but he lost weight due to the stress and the tumours sucking up the nutrients." 

The elder brother googled " hamster tumour surgery" or something like that and found Toa Payoh Vets. Now, the hamster is so thin, the anesthetic risk is very high. If he can survive the anaethesia, he would be OK with the chest tumour removed first as the left armpit tumour is large too. There would be insufficient skin to stitch up if both tumours are removed. In any case, the chest tumour can be sliced off in 2 seconds as it is now loose under the skin.

Vets who do not wish to operate on hamster tumours may do the owner a service by referring him to another vet who does it. 


 
 

1183. **How to treat kidney failure in an old cat

May 1, 2105

Most Singapore owners do not comply with instructions on home treatment of the cat with kidney diseases.

CASE
Fatty, female spayed, 10 years old.

April 29, 2015
Anorexia 3 days. Not drinking 3 days. Diarrhoea (dark chocolate stools) 4 days.
Fever 40.5C.


I review the medical records today

HISTORY
Feb 2, 2015. 
Mastectomy. Left mammary gland 1 (MG1) tumour with left axillary lymph node enlarged. Histology -  Invasive ductal carcinoma (malignant tumour).  Blood test - Urea 5.3 (7.2-10.8), creatinine76 (71-160).  No leucocytosis. Platelets low  60 (300-800).
However, the cat had been vomiting for the past 2 weeks and the "left" kidney was painful on palpation.

Feb 28, 2015. Vomiting. Treated by Dr Daniel.




Mar 7, 2015
Has vomiting for the past 7 days. Thin but no fever. Kidneys painful on palpation.
Blood test - kidneys normal.  Urea 7.3 (7.2 - 10.8), creatinine 93 (71-160). Total white cell count 2.3 (5.5 - 19.5). Neutrophils 24% (35-75), Absolute 0.55 (2.5-12.5). Platelets low 78 (300-800).
Tiger Balm ointment smell in apartment.  Not to use Tiger Balm ointment which might have been inadvertently rubbed onto the cat.

PRESENT CONSULTATION
Apr 29, 2015
X-rays as kidneys are painful on palpation and enlarged with the cat growling during palpation.
Kidneys enlarged  No blood or urine tests to reduce medical costs. Given drip + baytril before going home.
Advised dialysis 200 ml Hartmann's Solution/day, next 4 days. Fortekor 5 (1/2 tab/day),, Baytril and Prescription K/D for 5 days.

FOLLOW UP
May 1, 2015
Cat is his normal self. No diarrhoea. Eating the usual Friskie dry food.
Did not accept Fortekor and K/D.

CONCLUSION
Although the blood test did not show kidney disorder so far, it is possible that the kidney failure has just started. Probably the cancer cells had gone to the kidneys, causing pain and enlargement. Owing to the need to reduce medical costs, no further are done to check on the kidneys.

I advised crushing the Fortekor dose into 4 portions of powder. Mix with honey and feed the cat. The K/D is to be fed by hand at 5% till 100% or switch to the dry K/D. The owner had given one SC drip. It is difficult to do it.  Wrap the towel around the cat to prevent clawing.

VIDEO

Tuesday, April 28, 2015

1182. A stray cat eats but spits out canned food

April 27,2015

In Singapore, this stray cat has no proper home but the cat feeders ensure that she has food and water. "For the past 3 days, she would eat but spit out the canned food," the retiree said to me.
"There could be a fish bone lodged inside the throat," I advised X-rays. Stray cats love fish and some people will feed them with left over fish with bones.


The cat pawed me when I tried to open his mouth. Foul breath. The lower sides of his gums appeared blood red with ulcers. Hence the bad breath.

X-rays showed ulcerated pharynx and proximal oesophagus with gas.




After an anti-inflammatory and antibiotic injection, the cat was active and ravenous and the caregiver is much happier.  









1181. **How to prevent a hamster's subconjunctival abscess from recurring - video

Sunday April 25, 2015.
Recurrent eye abscess.
The owner wanted the hamster home on the same day as the treatment of the abscess some 5 weeks ago. She disputed that I had advised her how to do post-discharge care. I had told her verbally to use a cotton bud tip to rub above and below the skin wound to express out the pus, daily. In this way, any residual pus would be let out and the abscess would not recur. She only put eye drops.     

This educational video teaches vets how to handle this problem and to prevent the abscess from recurring. 

A small skin incision heals too fast if the owner does not express the pus on the second day. There will be pockets of pus still inside the skin. So the abscess recurs. This video shows how an abscess is treated by me at Toa Payoh Vets. Isoflurane + oxygen gas anaesthesia is used here. The whole process of lancing, curetting, irrigating and draining the abscess takes around 5 minutes.
The hamster is OK and will be in-patient for 2 days.




UPDATE
On Day 2, I reviewed this gentle chubby hamster. I expressed more yellow pus from the incision wound. By inching out the residual pus, the wound can heal without another abscess popping out in the next week.

The owner phoned and her male friend came to check the hamster. She asked whether the hamster could go home. I said no. Hamsters are family members and so the lady owner did not want her in-patient but would not want to pay for a recurrent abscess.   

POST DISCHARGE NURSING ADVICE IN WRITING.
The vet must let the owners wanting to bring the hamster home on the same day, they will have to bear the responsibility of post-discharge nursing and to pay in full should the hamster recur. This should be in writing to prevent any misunderstanding of the responsibilities of post-discharge care and much unhappiness in having to pay again for treatment. 

This hamster stayed 2 nights in-patient and was cleared of pus on Day 3.
On Day 2, I could express pus from the closed wound.
On Day 3, more pus was expressed although the wound had closed (video). After that, I phoned the owner to bring her home. She should not have any recurring abscess within the next 2 weeks.

 

Friday, April 24, 2015

1180. ** A FLUTD cat recovers from acute kidney failure

Friday Mar 27, 2015
2nd in-patient period at Toa Payoh Vets
Male, not neutered cat, 1.5 years old
Owner wants him to stay another 2 days. He went home after 2 days in-patient during the first visit.

History
Bladder obstruction some 2 weeks ago. The first vet had unblocked the bladder and sent the cat home after 5 days in-patient.
Yet the cat was still passing blood in the urine and had inflamed prepuce. He was not eating and was dehydrated.

The owner consulted me as a 2nd opinion on Mar 17, 2015.

I had palpated much enlarged painful kidneys (X-rays in another video). Therefore, the urethral obstruction blocking the flow of urine, putting back pressure enlarging the kidneys 3-6X and also causing bacterial infection and kidney failure (blood test results of high blood urea nitrogen and creatinine, leucocytosis and neutrophilia from the first vet).

After the first vet sent the cat home, the cat would not eat and it was difficult to give medication orally. Anorexia, tongue and lip ulcers are signs of uraemia as the cat had acute kidney failure. The cat was dehydrated and hypothermia (below 38C). Lethargy. No hope of survival?
This was acute kidney failure due to bacterial infections of the kidneys.

The first vet's clavulox antibiotics and treatment did not eliminate the bacteria. I got a bacterial culture and antibiotic sensitivity test of the urine. The bacteria was resistant to clavulox.


The video shows the cat after 2 days of treatmet at the 2nd in-patient treatment at Toa Payoh Vets

After antibiotics of Baytril, SC fluids of 200 ml for the next 2 days, the kidneys reduced in size (by palpation).The cat was not happy when the kidneys were palpated as there was still nephritis (see video).
 
 

CONCLUSION
The enlarged kidneys would be due to the back pressure of the urine from the obstructed bladder. The owner did not know that the cat had difficulty in urination as he shares a common toilet floor with the other 3 cats. The first vet relieved the obstruction and had treated him as an in-patient for 5 days.

This was a gentle cat and so did not claw the vets during fluid therapy. As the family could not accept pork in the prescripition diet, the Royal Canin Renal diet was reported not to contain pork. This was fed to this cat since he went home after the 2nd in-patient treatment.


FOLLOW UP
April 23, 2015
SMS
The owner was contactable by SMS. The cat is back to normal, eating only the Royal Canin Renal food. Normal temperature. So, it is good outcome. This cat is a favourite of the father as this cat meows as if talking to a person whenever he is spoken to. Unlike the other 3 neutered cats in the apartment. 

So, he is much loved by the father who told me that he did not want to neuter him as he would become dumb like the other 3 cats.

There is a learning lesson here. Many young Singaporeans do not greet or say good morning to the parents or superior officers. Be communicative and you will be most appreciated by the hand that feeds you or mentors you. 

Blood test values


 Normal Feline & Canine Blood Chemistry Values
Blood, Temperature , Urine and Other Values for Your Dog and Cat  by Ron Hines


http://www.2ndchance.info/normaldogandcatbloodvalues.htm