2321. Legally threatened

Oct 2, 2015

"I will make a complaint," the dog owner threatened when I said I would not pay for the bills of another vet (Vet 2) who had hospitalised and treated her dog for paraplegia on Sep 30.

On Sep 30, 2015, at around 11 am, I had given a subcutaneous injection of antibiotic and anti-inflammatory above the neck area as the dog had multiple skin lumps. The owner attributed the lumps to a new shampoo. The dog had painful ears and I prescribed an ear ointment to be given at home. The dog was normal on leaving the clinic and at home.

In the afternoon, the owner phoned me to say that her dog was lame in the left hind leg. I advised her to wait and see as she had no time to bring the dog in for an examination. In the evening, the dog was lame in the right hind leg. She phoned and said that it must be my injection hitting a nerve, hence causing the dog to be paralysed. "I don't trust you," she declined my advice to bring the dog for an examination.    

I referred to Vet 2. She phoned me again to say that Vet 2 would charge for after-office hours. Then she suggested that I examine the dog. I did not retort that she had shouted that she did not trust me. Now she asked me to examine the dog. 

I went to the clinic to examine the dog at 9.30 pm with Dr Daniel. The dog was paralysed in the hind limbs. I palpated the spinal area. There was a pain reaction on the T10-L4 area. The husband could see the reaction. The dog's hind legs had no placing and pain reflexes.

"There must be a traumatic injury to the back," I said. "Some heavy objects had fallen on her back or she had fallen down injuring her back."

The husband recalled that the dog had struggled vigorously when ear drops were applied onto the ears.

"Was the dog on the floor when you applied the ear drops?" I asked.
"Yes," the husband demonstrated how he held the dog around the back of the rib cage area with his hands to apply the ear drops.

He accepted the referral to Vet 2 who took X rays and warded the dog overnight with a drip.
The dog tried to stand on her left hind leg the next day but not on the right hind leg.

The owner then phoned me demanding that I pay for Vet 2's fees. When I said no, as my injection was not the cause of this hind limb lameness, she threatened me legally. She said that the dog was normal before my injection and wanted to show me proof.

"No need to show me the pictures," I replied. "Your dog was normal at the clinic and when leaving the clinic walking to your car. She was normal at home till the late afternoon."

As the owner was insistent that I was the cause of the dog's lameness, it was best for me to shout up and not provoke further anger.  I had not given any injections in the hind limbs. The dog had pain in the back spinal area. Vet 2's X-rays did not show any slipped disc and he had told the owners that my injections are commonly given by vets without any injection causing paraplegia.

When an owner said "I don't trust you", I should have asked her to seek a second opinion. I did not charge for the after-hours evening examination when she did not want to consult Vet 2 so as not to pay Vet 2's fees. Now, she threatened to make a complaint.  This is one of the sad cases all vets must handle with empathy with the interest of the dog in mind.   

2319. Follow up: The young neck-extended chihuahua develops more red spots on her shoulders.

Sep 30, 2015

The young lady in her early 30s came to buy 2 bottles of multivitamins for her Chihuahua who had presented with her nose pointing skywards some 4 weeks ago. (Another blog).

"How's the dog's neck extended posture now?" I asked.

"No more problem," she replied. "I have had stopped the heart medication for a week and she has no problem sleeping at nigh. A few soft coughs now and then."

"How about the ringworm on your wrist?" I asked.
"No more inflamed," she showed her right wrist. "I don't get ringworm now even when I held my dog. But more red spots appear on my dog's shoulder area!"

Some 2 weeks ago, the dog had generalised ringworm and she had her left wrist skin infected too.
I did not prescribe anti-ringworm medication as she was concerned about more medication since her dog was on heart drugs. I advised clipping bald to remove all contaminated hairs. She would be giving the anti-fungal wash and cream daily.
She had asked the groomer to clip the body but not the head. She clipped recently and saw more red spots.

Many owners do not bring their dog in for reviews and so what she said about the red spots could be ringworm or could be clipper burns or other reasons . A month had passed. Most of my cases of generalised ringworm had cured but this dog had more red spots.

"It is best for me to review and check on the multiple red spots, with the dog present," I explained. 

For various reasons, many Singaporean dog owners do not come for a review and in this case, she wanted to buy the multivitamins and do-it-herself treatment of the ringworm with the antifungal wash and cream.

She would bring the dog in for examination as it is not possible to confirm whether ringworm had spread or not.

2318. Ticks in Singapore dogs - email queries from one owner.

Sept 30, 2015
EMAIL TO DR SING


Hi
I've a mid sized dog (Singapore special 15kg)
Noticed she had black sesame seeds falling off her which had blood when burst on Sunday. Suspected ticks.
Searched online and apple cider vinegar wash was recommended.

Did it for 2 days. Seemed to repel the bugs. More fell off. Pet store recommended me carrington dog wash (which I diluted with more water - the instructions said 2 cap full to 1L water, I used 5 caps to 3L). I tried that, combed off some. Not all dead. Some articles mentioned dogs would salivate but she didn't.

I was told to put frontline plus 48 hours after carrington. Or should I take her in to see the vet? And is it necessary to test for tick disease?
All along she's eating well, active and alert without scratching much, only shakes body occasionally, so we didn't realize she has ticks.What do you advise?
Hope to hear from you soon.

Best Regards,
M


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EMAIL REPLY

Thank you for email. I am Dr Sing K Y from Toa Payoh Vets.

My advice is to get your dog examined by your vet, get a blood test done to screen the health of your dog. Another test to check whether your dog has tick-borne diseases.


Tick infestation is the most common ectoparasitic disease in Singapore dogs.

2318. Coincidences A Rottweiler and a cat - tibial fractures

Sep 30, 2015

Just 2 days ago, I had breakfast with a senior vet of over 70 years old at Potong Pasir. We ate laksa which is high cholesterol. I did not drink the soup. He drank every drop, ate the clams which I gave my portion to help and would leave the egg yolk uneaten. Yet he had no high cholesterol levels due to his medication.

 He mentioned that a Malaysian vet phoned him about infections in a Rottweiler with tibial fracture and what are the options? Amputatation of the leg?  Euthanasia?  I suggested Antirobe antibiotics.

Today a cat came in with tibial fracture. The stray cat activist is a woman in her late 50s and had been feeding stray cats for the past 20 years. Her monthly feeding bill using mainly Iams cat food, is around $800.


"I have 6 cats now. This cat is around 3 years old and came flopping down in front of me. I had no intention of adopting another cat."

Her cats would watch the birds from the windows every day. She had wire-meshed all her windows except the one in the kitchen. So, this newcomer fell 8 storeys down. Vet 1 had given this cat the painkillers, antibiotics and an IV drip. He had an abdominal X-ray which showed no ruptured bladder or kidney damage. The other 2 X-rays were emailed to me.

The solution was to insert a pin of appropriate diameter to join the 2 tibial fractures together.

 

"I can only afford to feed the stray cats," the retiree told me that her cat food bill was a large amount. "I can't help them when they are sick."
"I do have volunteers sometimes,": she mentioned one lady who would not contribute any money to buy the cat food.

"Is she working?" I asked.
"Yes,"
"It is hard to find volunteers and so you are fortunate," I said.
"She does not want to pay for the cat food, but she feeds a particular cat every day from my supply."

The commercial dog and cat food costs keep going up every year as Singapore faces higher labour and rental costs every year. The government also increases rentals of commercial premises every year and so these escalating costs eat into the savings of this retiree.

It is a difficult world for the stray cat feeders. This cat's fracture of the tibia was in mid-shaft. A pin was inserted and will be taken out 6 weeks later. A small 2 mm of the pin protruded


From the X-rays and observations on the 2nd day after surgery, the cat was normal. Hence, the kidneys and bladder were not affected by the cat falling 8 floors in a Singapore apartment.

AN ALBATROSS ROUND MY NECK

"Should I join my friends on a China tour?" the retiree caregiver asked me. "My family vet says that it will take months for the fractured tibia to heal."

She had not taken holidays for many years since she started caring for 30 stray cats and her own 6 cats  every day.

I had told her that the pin needed to be taken out 6 weeks after surgery but she had another opinion from her family vet who said a few  months. Her planned travel was 7 weeks from the surgery.

She was just worried about the 30 community cats in Tampines  being deprived of food.
"Can you get the other lady volunteer to help you?" I asked. The lady volunteer would only feed a particular cat with food provided by her. She must ask her and make it convenient for her to do it.

"As for your own stray cats including the one who fell 8 storeys, can you find a pet sitter?"
"Yes," she replied. "She charges $35 per day."
"Can you find somebody who charges cheaper?"

"Looking after so many cats is like an albatross round my neck," she had done a very good job. But she is from the earlier baby boomer generation who does not know how to use social media to get donations and volunteers. So she is all alone with no interest in travelling.

I assure her that her leg fractured cat will have healed by 6 weeks as her travel would one week later.  

"Take a break," I told her as she was worried about the stray cats.

2317. A cat stills caterwauls just after spaying

Sep 27, 2015
EMAIL TO DR SING


Hello Judy,

I spoke to Dr Sing on the phone this evening regarding Greedy's active meowing at night even after sterilisation.

Attached is a voice clip of her meowing that Dr Sing has asked me to send him, would he be able to tell if this meowing comes from the remaining hormones of being on heat?

It's disturbing my sleep daily.

Thank you so much!



A

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REPLY FROM DR SING

Meowing is due to the effects of the residual female hormones in the cat. The cat had been caterwauling for a few nights before spay. Within a week, there should be no more meowing due to the heat period. Alternatively, come for the Ovarid tablet to stop the meowing.

2316. A 6-month-old cat has no scrotum but has nightly erections

Tuesday Sep 29, 2015

The young fair lady in her late 20s wanted her male cat to be neutered urgently. She did not say why and I did not ask. I thought it would be caterwauling as the male cat has matured. The loud meowing and crying would disturb her sleep and that of the neighbours.

I examined this greyish-white Persian X cat pre-op. He was a bit overweight and was fit for anaesthesia. He had a normal prepuce and penis but no scrotum. I asked my assistant to clip off the long hairs in the area between the anus and the penis. No developed scrotum and therefore no descended testicles. This was rare in cats. I checked the inguinal areas as sometimes, the testicles were lodged there. None were present.

So, there was no neutering unless the lady agreed to my opening the abdomen to take the abdominal testicles out.

"Is your cat making a lot of noises at night, wanting to go out?" I asked when she returned to pick up the cat one hour later.

"No, no," she said. "But over the past 2 weeks, I noticed that he humps the pillows and his penis is erect every night. That is why I wanted to neuter him."

In this modern age, she showed me her smartphone clip of the red and engorged penis. She had not told me earlier as this was not a topic for a young lady to talk about. It was only when I told her that the cat had no descended testicle that she volunteered the information.


"This nightly incident may be due to the cat licking his penis as he may be suffering from FIC (Feline Interstitial Cystitis). FIC is an inflammation of the bladder. The cause is said to be due to stress leading to bladder mucosal changes and painful and difficult urination."

"But I do not see him as having difficulty in urination," the lady said..
"You work the whole day and so you may not know. Has he got his own litter box since you have had got a younger male cat?"

"The younger male cat does not stress him," she said. "At first, he was hissing at the new arrival and so I separated them. Later, he befriended the younger cat and both share one litter box."

She showed me an image of the younger cat and also his scrotum which was obvious and well developed to around 1 cm across as compared to 3 mm across in this cat with no scrotum.She showed a 5-second video clip of both of them playing and biting each other.

"Stress could be due to the arrival of another cat," I said. "It could be due to the need to share a litter box and to share space. Cats are more sensitive than dogs to such matters."


The lady was doubtful.  However she said, "This cat is a very timid cat, just like the one my mother had in Beijing. He will freeze like a statute if I take him outdoors."

So, this was a nervous cat that would be more susceptible to stress than the normal one. Based on this history, I would say that he is suffering from the early stages of FIC. His bladder was full as well but then the owner said she had taken him out early to Toa Payoh Vets and therefore he had no time to pee. The sedated cat released pale clear urine on the consultation table and the lady took several pieces of tissues to wipe off the urine.

"It is a coincidence that you have a timid cat as well as your mother. Did your mother's cat suffer from difficulty in urination?" I asked.

"Yes, at one time, her cat had to be catheterised by the vet in Beijing so that he could pee."


As the lady did not want any abdominal surgery to take out the retained testicles, I prescribed meloxcam at 0.03ml/kg orally for 4 days to relieve the pain. This cat was 3.3 kg and so he will take around 0.1 ml per day for 4 days. The lady will phone me as regards the penile erection behaviour. The cat would be separated from the other cat and has his own litter box.

I will need to follow up 4 days later 





 
     


 

2315. Puppy training. Cocker Rage and the tug of war play

Sep 28, 2015
A working mother and her son in his early twenties, after National Service full time, came to get their 4-month-old female Cocker Spaniel vaccinated the 3rd vaccine.

"You phoned earlier to make an appointment to get the dog spayed?" I asked. The son had phoned but I advised spaying at 6 months or 2 months after the heat. "The dog's private parts will not develop to adult size if she is spayed at 4 months. She may have some difficulty in urination later. Since she is a house pet, it is best not to spay her at this age, although dog shelters and some sellers of pedigree dogs do that to prevent breeding."

As I opened the puppy's mouth to examine it, the Cocker suddenly snapped at me.
"This is a domineering female," I explained. "At this impressionable age, you need to train her to stop biting anyone. When she is in her rebellious adolescent age which is at 6 months, it will be very difficult to control her biting. She would have focused rage and anger and would bite anyone in the family if she does not like their petting. In Cocker Spaniels, there are male, not neutered dogs who will bite family members anytime when touched or when he does not like it. This is reported in some Canine magazines to be Cocker Rage."

The mother was surprised to know that there is a Cocker Rage condition. "My daughter used to tug at her toy from her mouth and she would growl," the mother said. "My daughter thinks it is fun to play tug of war."

"At 4 months of age, this behaviour must be stopped as she is receptive to training before the sexual hormones cause a dangerous killer adult dog. Dogs become adolescents at 6 months unlike people. If the puppy shows anger, grip her muzzle with your hand and say loudly "No."  I demonstrated (video).
Some people will smack the muzzle over their fingers as they train the puppy not to bite people."

After the demonstration, I cautiously open this puppy's mouth. She did not snap at me but protested with whimpering sounds. I asked permission for making an educational video with the son being the video-grapher.

As you can see in the video, the puppy did not bite me. But as I repeated this action, she did revert to her aggressive behaviour and snapped at me.

Training needs time, perseverance and rewards to show the puppy that she is loved but the family members are the pack leaders. So, the daughter has to stop the tug of war play.