June 1, 2015
Bright sunshine blue sky day. Vesak Day. The couple is free to bring their 3-year-old Shih Tzu home today as they are a working couple. Nobody at home.
Yesterday on Day 2, this dog had ripped out his urinary catheter. I checked that he had tried to bruise his surgical wound near the flank of the penis, with his e-collar. I gave him methone inj. 10mg/ml at 0.3 ml SC. He also had Rimadyl 25 mg tablet. I checked his surgical area. There was little pain on palpation and less bruising. He ate the U/D can and was very active. I videoed him peeing normally without one leg up.
At 3 years old, he appeared "obese" but actually he was broad-chested. The first vet had provided a good detailed examination report. She had said he was obese with body score BCS 8/9. She said he could have "urate" crystals and that X-rays of the bladder stones were too radio-dense to be urate stones. Urate stones are said to be radio-opaque in some reports but it is not true.
Free catch urine dipstick. pH 8, Protein 3+, blood 4+, leucoyctyes negative, "rest wnl."
The dog was super-active today and went home with instructions (Video on urination)
1. not to feed any more dry food as he may have a familiar tendency to develop bladder stones.
2. pee more than 2 times per day. Not practical as the couple works and nobody is at home during weekdays. So the dog holds his urine from 8 am to 8 pm waiting to go downstairs.
3. to measure volume of water drank/24 hour and record. Drinks lots of water.
4. to use dipstick monthly to measure pH, blood, etc and let me know
5. to send urine for lab test 6-monthly and if there are small crystals, I can flush out the bladder.
6. stones sent for analysis
7. U/D diet can be expensive. Eat canned food exclusively. No dog treats, rice, bread.
I don't know how many of the abovementioned instructions the couple will comply with.
Monday, June 1, 2015
Sunday, May 31, 2015
2177. Gigantic breast tumours in a 2.5-year-old cat
SUNDAY'S UNUSUAL CASE
A 2.5-year-old female rat with massive breast tumours of around 4" X 3" came in. She was eating well despite this gigantic tumour. I found it hard to believe but she was not emaciated and looked good.
The couple decided on surgery to remove the breast tumours despite the high anaesthetic risks. I prescribed antibiotics and pain-killers for 3 days before surgery. Surgery was done with Zoletil sedation and isoflurane gas maintenance. The rat was OK within 24 hours. Now the problem was the biting of stitches. She bit off two stitches. I advised daily cleaning and covering with a bigger plaster rather than several small strips. The wound should heal by granulation.
This is an unusual case of an older fancy rat surviving anaesthesia. Do not wait till the breast tumours become bigger or malignant before removal as anaesthetic risks are higher. Early removal saves lives.
A 2.5-year-old female rat with massive breast tumours of around 4" X 3" came in. She was eating well despite this gigantic tumour. I found it hard to believe but she was not emaciated and looked good.
The couple decided on surgery to remove the breast tumours despite the high anaesthetic risks. I prescribed antibiotics and pain-killers for 3 days before surgery. Surgery was done with Zoletil sedation and isoflurane gas maintenance. The rat was OK within 24 hours. Now the problem was the biting of stitches. She bit off two stitches. I advised daily cleaning and covering with a bigger plaster rather than several small strips. The wound should heal by granulation.
This is an unusual case of an older fancy rat surviving anaesthesia. Do not wait till the breast tumours become bigger or malignant before removal as anaesthetic risks are higher. Early removal saves lives.
2176. Clinical research injectable anaesthesia in a dog
Sunday May 31, 2015
My tried formula for a deep anaesthesia and good analgesia lasting 30 minutes, enough for a spay or neuter in a dog, is as follows:
Young dog (less than 2 years, healthy on physical examination)
10kg
Domitor 0.4 ml, Ketamine 0.5 ml IV.
Today, I have Max, 7-month-old Bull Terrier X, male to be neutered.
At 16 kg, this young dog was given below the formulation dosage
Domitor 0.4 ml, Ketamine 0.5 ml IV
The dog moved his head at around the ligation of the first testicle, around 10 minutes.
I gave 5% isoflurane + oxygen gas at 3 lit/min for 2 minutes and that was sufficient anaesthesia to complete the neuter.
CONCLUSION
The under-dosage was given to reduce anaesthetic risk but this was insufficient dosage without the need to top up with isoflurane.
Surgery must be speedy, accurate and complete. Proper planning is needed to be efficient.
Two ligatures of the spermatic blood vessels were performed on each testicle. No bleeding.
Baytril and tolfedine 2ml each was given post-op.
My tried formula for a deep anaesthesia and good analgesia lasting 30 minutes, enough for a spay or neuter in a dog, is as follows:
Young dog (less than 2 years, healthy on physical examination)
10kg
Domitor 0.4 ml, Ketamine 0.5 ml IV.
Today, I have Max, 7-month-old Bull Terrier X, male to be neutered.
At 16 kg, this young dog was given below the formulation dosage
Domitor 0.4 ml, Ketamine 0.5 ml IV
The dog moved his head at around the ligation of the first testicle, around 10 minutes.
I gave 5% isoflurane + oxygen gas at 3 lit/min for 2 minutes and that was sufficient anaesthesia to complete the neuter.
CONCLUSION
The under-dosage was given to reduce anaesthetic risk but this was insufficient dosage without the need to top up with isoflurane.
Surgery must be speedy, accurate and complete. Proper planning is needed to be efficient.
Two ligatures of the spermatic blood vessels were performed on each testicle. No bleeding.
Baytril and tolfedine 2ml each was given post-op.
Saturday, May 30, 2015
2175. A spayed cat still caterwauls. Why?
May 30, 2015
A mother and her young adult daughter brought in 2 two-month-old kittens for vet examination.
They were grey Maine Coon X bought from a home-breeder, a male and female. There were so much wax that I would advise ear irrigation rather than putting ear ointment and massaging. With ear irrigation, the large chunks of black wax get syringed out.
"I have another cat spayed by a vet," the mother said. "She keeps coming on heat, meowing loudly. The vet said it was natural and prescribed some tablets which stopped the caterwauling. Could she have not done a proper spay?"
"It is hard to say, but generally, any ovarian tissues or ovary left inside during spay will cause this caterwauling!".
"What is the solution?"
"To open up the abdomen and look for the ovary near the end of the kidneys," I said. "It will be a long incision."
The owners prefer no surgery and asked about the side effects of the pills given to prevent heat given by the vet for the last 2 years.
"After prolonged use, there may be breast enlargement or pus inside the stump of the uterus, called stump pyometra."
"Other solutions?"
"Injections of hormone every 3 months as in Myanmar cats will stop the caterwauling," I said. "The side effects are stump pyometra."
A mother and her young adult daughter brought in 2 two-month-old kittens for vet examination.
They were grey Maine Coon X bought from a home-breeder, a male and female. There were so much wax that I would advise ear irrigation rather than putting ear ointment and massaging. With ear irrigation, the large chunks of black wax get syringed out.
"I have another cat spayed by a vet," the mother said. "She keeps coming on heat, meowing loudly. The vet said it was natural and prescribed some tablets which stopped the caterwauling. Could she have not done a proper spay?"
"It is hard to say, but generally, any ovarian tissues or ovary left inside during spay will cause this caterwauling!".
"What is the solution?"
"To open up the abdomen and look for the ovary near the end of the kidneys," I said. "It will be a long incision."
The owners prefer no surgery and asked about the side effects of the pills given to prevent heat given by the vet for the last 2 years.
"After prolonged use, there may be breast enlargement or pus inside the stump of the uterus, called stump pyometra."
"Other solutions?"
"Injections of hormone every 3 months as in Myanmar cats will stop the caterwauling," I said. "The side effects are stump pyometra."
2173. VIDEO. A young Shih Tzu has a bladder full of stones and an abdominal testicle
POLLIKIURIA AND HAEMATURIA IN A SHIH TZU
-----------------------------------------------------------------------
Case report
May 30, 2015
"The dog bites," the couple said as I palpated the kidneys and the bladder. The dog reacted to kidney palpation as if there is kidney pain. The bladder was empty of urine and was the size of two grapes packed with hard gritty stones.
Vet 1 had taken urine tests and X-rays.
Urine pH 8 and numerous crystals suspected to be urates??
X-rays of bladder stones were too radio-opaque to be urates.
Had advised removal of retained abdominal testicle in one surgery as bladder stone removal.
"A retained testicle can easily be seen around the neck of the bladder," I told Dr Daniel. "It can be excised promptly by ligation in less than 2 minutes."
As this dog is "obese" at 8.5 kg, any prolonged anaesthesia is risky but abdominal cryptorchidism needs to be done at the same time to save on having to open up the abdomen again. As for the descended testicle, this can be removed another day to reduce risks.
Operation will commence after lunch and the dog will go home in 3 days, providing all goes well with anaesthesia. Stones need to be analysed as the prevention depends on the composition of the stones.
In the meantime, no dry food and give the dog plenty of water to drink.
SURGERY ON MAY 30, 2015
Red swollen bleeding bladder showing inflammation and damage from sharp bladder stones stuck inside the mucosa. Every fragment had to be flushed out after picking out as many as possible with forceps. The dog's urinary bladder was catheterised but he pulled out the Elastoplast-taped catheter overnight, despite wearing an Elizabeth collar.
The stones are sharp and may be urates as suspected by Vet 1. They will be sent for analysis.
To reduce anaesthetic time, no neutering was done.
FOLLOW UP POST OP
Sunday, May 31, 2015
2178. Clinical Research on methone. Day 3 - sharp bladder stone Shih Tzu goes home
June 1, 2015
Bright sunshine blue sky day. Vesak Day. The couple is free to bring their 3-year-old Shih Tzu home today as they are a working couple. Nobody at home.
Yesterday on Day 2, this dog had ripped out his urinary catheter. I checked that he had tried to bruise his surgical wound near the flank of the penis, with his e-collar. I gave him methone inj. 10mg/ml at 0.3 ml SC. He also had Rimadyl 25 mg tablet. I checked his surgical area. There was little pain on palpation and less bruising. He ate the U/D can and was very active. I videoed him peeing normally without one leg up.
At 3 years old, he appeared "obese" but actually he was broad-chested. The first vet had provided a good detailed examination report. She had said he was obese with body score BCS 8/9. She said he could have "urate" crystals and that X-rays of the bladder stones were too radio-dense to be urate stones. Urate stones are said to be radio-opaque in some reports but it is not true.
Free catch urine dipstick. pH 8, Protein 3+, blood 4+, leucoyctyes negative, "rest wnl."
The dog was super-active today and went home with instructions
1. not to feed any more dry food as he may have a familiar tendency to develop bladder stones.
2. pee more than 2 times per day. Not practical as the couple works and nobody is at home during weekdays. So the dog holds his urine from 8 am to 8 pm waiting to go downstairs.
3. to measure volume of water drank/24 hour and record. Drink lots of water.
4. to use dipstick monthly to measure pH, blood, etc and let me know
5. to send urine for lab test 6-monthly and if there are small crystals, I can flush out the bladder.
6. stones sent for analysis
7. U/D diet can be expensive. Eat canned food exclusively. No dog treats, rice, bread. Stone analysis to confirm urates will be available in one week's time.
I don't know how many of the above-mentioned instructions the couple will comply with.
Bright sunshine blue sky day. Vesak Day. The couple is free to bring their 3-year-old Shih Tzu home today as they are a working couple. Nobody at home.
Yesterday on Day 2, this dog had ripped out his urinary catheter. I checked that he had tried to bruise his surgical wound near the flank of the penis, with his e-collar. I gave him methone inj. 10mg/ml at 0.3 ml SC. He also had Rimadyl 25 mg tablet. I checked his surgical area. There was little pain on palpation and less bruising. He ate the U/D can and was very active. I videoed him peeing normally without one leg up.
At 3 years old, he appeared "obese" but actually he was broad-chested. The first vet had provided a good detailed examination report. She had said he was obese with body score BCS 8/9. She said he could have "urate" crystals and that X-rays of the bladder stones were too radio-dense to be urate stones. Urate stones are said to be radio-opaque in some reports but it is not true.
Free catch urine dipstick. pH 8, Protein 3+, blood 4+, leucoyctyes negative, "rest wnl."
The dog was super-active today and went home with instructions
1. not to feed any more dry food as he may have a familiar tendency to develop bladder stones.
2. pee more than 2 times per day. Not practical as the couple works and nobody is at home during weekdays. So the dog holds his urine from 8 am to 8 pm waiting to go downstairs.
3. to measure volume of water drank/24 hour and record. Drink lots of water.
4. to use dipstick monthly to measure pH, blood, etc and let me know
5. to send urine for lab test 6-monthly and if there are small crystals, I can flush out the bladder.
6. stones sent for analysis
7. U/D diet can be expensive. Eat canned food exclusively. No dog treats, rice, bread. Stone analysis to confirm urates will be available in one week's time.
I don't know how many of the above-mentioned instructions the couple will comply with.
Friday, May 29, 2015
2172. Ap Alert sensor
March 29, 2015
The vet's wife wanted to buy an Ap Alert sensor as her husband considered it very useful. If the dog stops breathing, there is the warning and if it breathes regularly, there is the regular beeping sound. She contacted another vet whose receptionist told her that she must wait till the product comes in from Australia. It would cost $35.
The supplier I sourced for her quoted $250. Her husband said to buy two as his wife did not answer the phone or called me back. I confirmed two but the wife said one would do. The supplier was angry at this change of mind and despite my confirming two, he would not sell.
"Some years ago, she ordered some equipment with price agreed at $580. My girl delivered it to her office," he said." She wrote a cheque of $500. My girl accepted it as she would have wasted her taxi fare in bringing it back. "This $58 meant a lot to me as I had few customers."
In another instance, she asked him to keep the equipment for her but did not buy it. He said another vet asked him for quotations and even asked him to inform other suppliers about the new premises. In the end, this vet did not buy anything from him nor inform him of his failure to secure any business.
Some vets would ask for quotations and buy elsewhere or directly from Australia but would phone him for repairs. One even used another telephone as he did not respond to her call.
The vet's wife wanted to buy an Ap Alert sensor as her husband considered it very useful. If the dog stops breathing, there is the warning and if it breathes regularly, there is the regular beeping sound. She contacted another vet whose receptionist told her that she must wait till the product comes in from Australia. It would cost $35.
The supplier I sourced for her quoted $250. Her husband said to buy two as his wife did not answer the phone or called me back. I confirmed two but the wife said one would do. The supplier was angry at this change of mind and despite my confirming two, he would not sell.
"Some years ago, she ordered some equipment with price agreed at $580. My girl delivered it to her office," he said." She wrote a cheque of $500. My girl accepted it as she would have wasted her taxi fare in bringing it back. "This $58 meant a lot to me as I had few customers."
In another instance, she asked him to keep the equipment for her but did not buy it. He said another vet asked him for quotations and even asked him to inform other suppliers about the new premises. In the end, this vet did not buy anything from him nor inform him of his failure to secure any business.
Some vets would ask for quotations and buy elsewhere or directly from Australia but would phone him for repairs. One even used another telephone as he did not respond to her call.
2171. The guinea pig's head tilts left - review after 1 week
May 29, 2015
I did not expect to see the busy father after the treatment of the inappetant guinea pig with the left head tilt 7 days ago. The 3-year-old guinea pig was eating 50% of the food and was very thin at 700grams bodyweight.
He turned up with his two daughters today on May 29, 2015 and I was surprised as most owners do not bother or care for a review when their rabbit or guinea pig has head tilt.
"There is much improvement as she tilts her head less," he was glad that the bodyweight is now 752 grams and the guinea pig was eating. He fed Vitamin C tablet crushed in powdery form and bought wood and mineral blocks, but the guinea pig ignored them.
"No more left nostril pus after your antibiotic treatment, but the left eye is still cloudy." He cared for this guinea pig much despite his busy travelling. "After 3 days of ear drops, she would object strongly to any more ear cleaning."
"I need to irrigate the left ear under isoflurane gas anaesthesia," I advised this procedure as the guinea pig had had painful ears with black soot-like substances. "To flush out the black sticky dirt inside the ears as the guinea pig had no ear cleaning for the past 3 years. Did you give her more space to exercise?"
"This time, I extended the living space by placing her bottle at a far end of the pen. In this she's got to walk a longer distance to drink."
Under anaesthesia, I checked the molars using my fore-finger to feel for molar spurs. No sharp cheek teeth. The front teeth was trimmed 2 mm shorter.
The guinea pig's left eye cornea was cloudy but much less. She would rub her eyes whenever eye drops were applied.
As there is less head tilt, we will wait another 7-14 days after the ear irrigation and another type of ear drop dripped into the left ear to check whether the head will no more tilt to the left.
I did not expect to see the busy father after the treatment of the inappetant guinea pig with the left head tilt 7 days ago. The 3-year-old guinea pig was eating 50% of the food and was very thin at 700grams bodyweight.
He turned up with his two daughters today on May 29, 2015 and I was surprised as most owners do not bother or care for a review when their rabbit or guinea pig has head tilt.
"There is much improvement as she tilts her head less," he was glad that the bodyweight is now 752 grams and the guinea pig was eating. He fed Vitamin C tablet crushed in powdery form and bought wood and mineral blocks, but the guinea pig ignored them.
"No more left nostril pus after your antibiotic treatment, but the left eye is still cloudy." He cared for this guinea pig much despite his busy travelling. "After 3 days of ear drops, she would object strongly to any more ear cleaning."
"I need to irrigate the left ear under isoflurane gas anaesthesia," I advised this procedure as the guinea pig had had painful ears with black soot-like substances. "To flush out the black sticky dirt inside the ears as the guinea pig had no ear cleaning for the past 3 years. Did you give her more space to exercise?"
"This time, I extended the living space by placing her bottle at a far end of the pen. In this she's got to walk a longer distance to drink."
Under anaesthesia, I checked the molars using my fore-finger to feel for molar spurs. No sharp cheek teeth. The front teeth was trimmed 2 mm shorter.
The guinea pig's left eye cornea was cloudy but much less. She would rub her eyes whenever eye drops were applied.
As there is less head tilt, we will wait another 7-14 days after the ear irrigation and another type of ear drop dripped into the left ear to check whether the head will no more tilt to the left.
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