2981. An 8-year-old Silkie has sterile struvite urolithiasis

Aug 29, 2015
SilkieXYorkshire, Female, 8 years
Consulted Toa Payoh Vets for right hindlimb lameness. Patellar bones luxate easily medially in both hind limbs. X-rays for sprained knees showed lots of bladder stones.
No complaint of blood in the urine or peeing problems.




URINE TEST
pH 8
SG 1.024
A trace of blood.
Crystals amorphous phosphate 3+
Little  white cells  3
No red cells.          0
No bacteria



Advised S/D to dissolve the stones.
X RAYS

A rare case of sterile struvite in a dog. Almost 99% are infection-induced struvites with microbial urease involved. Hence, the owners did not know about the bladder stones till X-rays for lameness. These stones can be dissolved by S/D diet and change to C/D diet later.

Sometimes, a rare case appears. Urine must be collected to test for crystals.  

2980. Doing charity work in Vietnam

Sep 1, 2015

The Straits Times report headlined "ICA explains why some Viet woman turned away at airport".
The Immigration and Checkpoins Authority (ICA) had sent back several Vietnamese women at Changi Airport as they could not explain to officers why they wanted to enter Singapore. The Vietnamese Civil Aviation Authority wanted to know why. The Vietnam Embassy's second secretary Nguyen Cong Huan met the ICA officials and was satisfied with the explanations on entry procedures which applied to visitors of all nationalities and that ICAhas interpreters to help those who cannot communicate in English. 

"The ICA does not have interpreters. They don't care. No explanations are given. They just end the woman back," the Singaporean who married a Vietnamese wife said. Before he married her, the ICA had prohibited her from entering Singapore on two occasions. She was detained in a room and put on the plane home. She could not speak Mandarin or English. There was no interpreters."

"The ICA says they have interpreters," I referred to the Straits Times clipping he showed me. "Are you able to gather evidence like an investigative reporter? What do you want to get blacklisted now that your wife had been given a long-term pass to stay in Singapore?"

This man had to accompany his wife every month for 4 years to travel out of Singapore as she was given a monthly visitor stay. Four years. "According to the law, it should be 3 years," he said. "The ICA does not bother to check on whether mine was a sham marriage. They just give my MP the standard rejection letter."

"The ICA officers are overworked," I said. "It is up to the individual to persevere." He did and now his wife is on a long term pass. After 4 years and many petitions. 

CHARITY WORK IN VIETNAM

The man wanted to build 10 houses and repair leaking roofs and tile the flooring of houses in the villages. The village headman told him to get approval from the District Officer. He wanted to do the charity work by himself. The District Officer wanted him to deliver the cash and goods.

"Unless you have a trusted respected person in the District," I advised. "You will not be permitted to do charity work all by yourself. This is the reality. The other way is to stay in the country for many years and get the connections and respect or partner with a local of good standing as some Japanese donors have had done in building schools in Myanmar villages. No do-it-yourself. It is not the way."

"The District Officer even checked whether I was living in the villages without permission," he said.

Doing charity work in Vietnam, as in all developing countries, is not so straight forward. You need the locals of good standing and influence.     

2979. A spayed female cat had recurrent breast tumour and died.

Sunday, Aug 30, 2015
Female spayed cat, 10 years old passed away at home. In the last 2 weeks, the breast tumour recurred and grew fast, the owner said.


HISTORY
Feb 16, 2015.
Mastectomy, Left mammary gland 1 enlargement,  8cm x 6 cm x 0.5cm excised.  Invasive ductal carcinoma. Lymphvascular invasion is seen.

Mar 7, 2015
Thin, vomiting. Painful kidney (left).  Total white cell count very low. Neutrophil % 24%, 0.55 absolute numbers low.  Platelet very low. Had used tiger balm ointment on cat or surroundings.

TODAY
Aug 30, 2015
Left mammary gland 1 and another nearby.

Spayed cats may develop breast cancer but rarely.

2978. A cat has dislocated left hip

Aug 28, 2015. Yesterday, one 3-month-old rabbit dislocated his right hip. The owner wanted closed reduction rather than doing nothing as Vet 1 suggested. Vet 1 had said he could not reduce the hip joint and suggested doing nothing. The rabbit has a right hip sling after putting the femoral head into the hip joint. The owner did not want any surgery as the rabbit is only 3 months old.


Then another case of dislocation of the hip in a cat abused by somebody. He was missing and found to be lame.

The left hind leg was shorter than the right on extension. X-rays to confirm and taken today.
Sedation is necessary for proper X-rays as the hind legs must be extended.

In this cat, 4.4 kg bodyweight:

xyla 0.5+Ket 0.3 IM
Reverzin 0.05 ml IV (or IM) given to reverse xylazine.

The owner wanted closed reduction and a sling was applied. The cat stained his bandage after peeing. I asked the owner to wash it off. For other "looseness" of bandage or hairs stuck, I asked the owner to bring the cat down as it is impossible to "diagnose" and "advise" over the phone. So far, the Cavalier King Charles and the rabbit, both given slings, had no complaints.

X-rays for this cat are as follows:

Rabbit hip dislocation 3 months old

Closed reduction may be possible if done early.

Follow up: A 9-month-old Miniature Schnauzer cannot pee

Aug 26, 2015.

This case illustrates the typical challenges many Singaporean dog owners face.
Most vets have no time to follow up as it is time-consuming. Today, I followed up to find out whether this brown male Schnauzer stlll has difficulty in peeing. (Video done July 2015) since he was given dry Canine C/D, no dog treats and other food after 4 days of in-patient and catheterisation for urethral obstruction (small bladder stones around 4 mm across was flushed out). The owner did not want blood test or X-rays, but the clinic did a blood test free of charge.   

"He pees a lot now," the mother of 2 boys, 10 and 11 years old was happy. "Neighbours said he has put on weight."  That was good news. The stools are "nice" in a continuous roll when the dog was fed C/D.

FINDINGS
1. Jan 2015. Dog was purchased at 3 months of age. Fed dry food from pet shop.

2. May 2015. Changed to a different brand of dry food called Osbourne as pet shop operator said it is better, more protein. Dog vomited often after eating this dry food and the earlier brand. So added canned food. Owner thought the dog ate too fast, so vomiting occurred. 

3. Jul 2015. Dysuria. Blocked bladder. Catheterised. Small bladder stones sucked out.
    4 days of inpatient. Did not want x-rays or blood test.

4. Aug 26 2015. Follow up on dysuria and C/D diet.  No more problems. He peed a lot for the last 2-3 weeks. Stools are well formed and in a roll

5. Urine test
pH 7, SG 1.020. Nitre +, Protein 4+, Ketones +, Blood 4+. White blood cells 576/uL. Bacteria +. No crystals. Yet around 3 small crystals were sucked out during catheterisation.

6. Blood test
Liver enzymes ALT/AST  159/102   (<59 br="">Urea 49.5   (4.2-6.5)
Creatinine 691  (89-177)

Total WCC  37.3  (6-17)
N 83% (60-70)
N absolute 90.96 (6-11)
Platelets  78 (200-500).  The dog has sepsis and kidney failure.

DOG PYSCHOLOGY
1. The mother is the disciplinarian of the dog.  Would crate him for most of the do. He will bite things in the apartment including the crate playpen and the younger son.
 
2. The younger son, 10 years old is bullied by this dog. He complained to his mum that his leg is painful from the dog's bite. There are bruises. The son would run when the dog is let out. The dog would chase him as a prey and bite him. The boy is encouraging this attack bite behaviour.

I advise:

1. grip the dog's muzzle and say "no biting" when he chases the younger boy.
2. place him into the play pen when he starts "bullying" the boy in Primary 4 class. .
 
3. Now the dog is nearly 11 months old. Not neutered as the owner did not want to do it.
He pees many x a day, every 20 minutes. The mother will estimate the 20-minute interval and placed him inside the playpen bought 2nd hand from the pet shop. It has a pee tray which she lined with pee pad. This routine is still present as other family members feel that the mother is too strict on this young dog.

CONCLUSION

No recurrence on C/D diet. Strictly no other food or dog treasts.  Schnauzers are prone to urinary stone formation.
 
Early neuter will have prevented this need of the dog to urine mark. The owner has to place him into the play pen to pee every 20 minutes. She did not realise that he is urine marking.

2975. INTERN. A 17-year-old Shih Tzu barks all night long

Aug 25, 2015

The parents and the young adult son came in to euthanase this 17-year-old Shih Tzu who barks all night long. The parents have to work and have no rest. They used to bring the dog down the apartment to the grass to pee at 5 am and 10 pm but now, they had to do it at 2 am.. The dog would not pee at home even at 17 years of age. He was kept in a very good condition although he had difficulty standing up.

Vet 1 had prescribed heart, liver and joint disease medication. Most likely, Vet 1 did not want to put the dog to sleep.  The frequent night barking led to this decision to euthanase as the parents have to work.

"Take time to think about euthanasia," I do not advocate euthanasia for dogs that can eat. Is there another solution?

I advised:
1. No water after 6 pm so that the dog does not need to go downstairs.
2. Antibiotics for possible bladder infection due to holding of urine for long periods of time. No urine test is done to lower medical costs. 
3. Medication. Sleeping tablets adjusted for effect at 10 pm.

The owners decided to accept the medication and the dog barks less. The dosage is being adjusted and it is only 3 days since I saw the dog. This family loves this old dog very much to undertake this solution.