2975. A 1-year-old guinea pig has stone stuck in urethra

8 days later, on Jul 13, 2016. GP collapsed overnight, glassy-eyed, not moving. Has fever but had not eaten on his own for past 8 days. Hand fed and given water 500 ml /day

X-rays show bladder obstruction by stone now.

2974. Women who are afraid of dogs

July 13, 2016

 

Yesterday, I was interviewed for a "success story" to inspire young generation who wants to be vets. How do you define "success"? Lots of money and big chain of vet clinics? I was surprised to talk to a lady interviewer who could not be present within 1 metre of any dog, big or small. This dog worrier was chased by big dogs when she was 3 years old. Now her husband loves dogs but cannot keep one forever.

Later in the evening, I met a Junior College lady who was in similar position at my daughter-in-law's birthday dinner yesterday. She tried to avoid my son's dog who went near her to get some food. So I sent the dog away behind closed doors of the kitchen. Poor Gatsby.

Two days ago, another of my client had to send the son's dog sent away or put to sleep as his wife did not like dogs. They were downgrading to a smaller flat. Fortunately, the maid who had to find a new employer loved this oldie and the new employer did not mind having the dog. When the dog was sick, the ex-employer spared no expenses to get her operated and she is well today.

What a coincidence to get 3 true dog stories in a short time.

2973. Toa Payoh Vets' Tips: How your old dog or cat can live longer lives?

Most pet owners in Singapore live hectic lives. After an intense care for their puppies/kittens, the senior pets are just left alone. It is usually too late for many pets  when they are sent to the veterinarian for some chronic disease problems. Veterinary costs become high as the pet is in poor health.

Age of Senior dogs:

Small and Medium-sized breeds: Over 7 years

Large and Giant-sized breeds: Over 5 years.

For those who may want their senior dogs to live longer, here are the following recommendations:

1. Veterinary examination and vaccination every 12 months.

2. Blood tests to check for diabetes,liver and kidney diseases.

3. Urine tests to check on bladder and kidney infections and presence of stones.

4. X-rays if necessary for arthritic hip joints/urinary stones/abdominal tumours.

5. Ultrasounds for chest/abdominal tumours

5. Dental check up and scaling every 1 year.

6. Heart check for murmurs and heart diseases.

7. Vaccination booster every year.

8. A veterinary discussion about the delay in senility, obesity, behavioural problems, skin problems and any questions related to each individual dog.

TIP

Early spay or neuter at less than one year old prevents many of the diseases associated with the reproductive hormones. For example:

1. Pyometra of female dogs, not spayed

2. Breast tumours of female dogs, not spayed

3. Testicular tumours

4. Perineal hernias of male dogs, not neutered

5. Circum-anal tumours of male dogs, not neutered

TIP

Yearly dental scaling prevents

1. Gum diseases

2. Carnassial tooth abscess

3. Bad breath due to rotten loose teeth

Many case reports and videos are at www.toapayohvets.com

The average life-span of a dog in Singapore is 12 years. Oldest ones live up to 20 years. However, many die before they are 12 years of age due to bad health and senility and other preventable causes such as bacterial infection of the heart valves due to severe gum diseases, pyometra, kidney diseases, diabetes and breast tumours.

+65 6254-3326, 9668-6468

judy@toapayohvets.com

for appointment
www.toapayohvets.com

2972. A 15-year-old cat has bladder and kidney stones now

Bladder stones of this 15-year-old cat were removed some months ago at Toa Payoh Vets. I advised change to Feline C/D diet to prevent recurrence. The old cat just would not eat the new food which should be given gradually.

So, the owner fed back the old dry diet.
Recently, the cat was ill and x-rays showed multiple stones in the kidneys and bladder.

A young guinea pig cries "for attention" for the past 7 days and had difficulty walking (bladder stone)

July 5, 2016



Around 2 weeks, drinks around 250 ml water per day compared to over 500 ml per day earlier.
New hay brand (Orchard Hay small pet select) fed since 2 weeks ago as the usual brand was out of stock.

Vegetables stopped 1 week ago. Carrots, wheat grass, coriander
Cries for attention for past 1 week ago

Stools look normal in shape and size, around the same amount
Urine brownish. Normal colour was yellow.

The other 3 guinea pigs are OK.


Bladder stone caused pain in the bladder and difficulty in walking in the past 2 days. The guinea pig stops eating. Stools appear to be stuck inside the large intestines. 

Pain killers and antibiotics. Fibreplex to move the bowels. Surgery to remove the bladder stone is not advised presently.

Difficulty in walking is a sign of bladder stone in some dogs and in this case, the guinea pig.

Abdominal swelling is due to impaction of the colon and not to gas, fortunately, unlike my other guinea pig case. A change of hay brand must be made gradually but in this case, the pet shop ran out of stock of the old brand.  The other 3 guinea pigs appear OK with the change to Orchard Hay.  

SCRIPT FOR RI INTERN. A 10-year-old Shih Tzu had dirty brownish red vaginal discharge

July 4, 2016

What evidence is there that the dog has pyometra? "This dog had no bleeding of heat during the past 3 years," the owner asserted and so, would not produce bleeding from the uterus.

On examining my records, the dog came in Jan 2015 for vaccination. I detected false pregnancy with milk seen in the mammary glands and swelling of the nipples. I advised spaying to prevent pyometra.

No news.

Today, July 4, 2016, the owner accepted the evidence of swollen uterus on X-rays and blood infection from blood test. His helper had shown blackish red vaginal discharge seen 2 days ago, snapped in her smartphone. Brownish-yellow discharge dribbled from the swollen private parts.

PHYSICAL EXAMINATION - Abdominal swelling + pain lower half

BLOOD TEST - leukocytosis + neutrophilia

X RAYS - swollen uterus radio-dense pus



The evidence pointed to pyometra.
Surgery together confirmed it (Video).

Nowadays, Singaporeans are well informed by surfing the net. So, it is best to produce evidence to come to a diagnosis of pyometra.

    

                                           Uterus is swollen as seen in the X-rays. They are being removed by Dr Daniel.

                                           The 10-year-old Shih Tzu has recovered from the operation and is well as at an update 2 weeks later

2968. Script & Final Video: An 8-year-old female spayed poodle urinates a lot

An 8-year-old female spayed poodle urinates a lot in the past 2 months. Polyuria is the medical word for this condition. It is abnormal.

What's wrong with this dog?  The owner brought the dog to Toa Payoh Vets. 

This video is a case study of an 8-year-old female spayed poodle that urinates a lot

Dr Sing from Toa Payoh Vets enquired more and found that
in addtion to polyuria, the dog has
Polydipsia (drinks a lot of water)
Polyphagia (eats a lot, always hungry)
Abdominal Distension


EXAMINATION
The main finding is a large painless anterior abdominal swelling 50% the size of a tennis ball. Dr Sing needed further lab tests to provide evidence of what's wrong with the dog. These tests are as follows:.


X RAYS

BLOOD TESTS
High serum ALT indicate liver cell damage, enlargement and necrosis

ALT = 1054  u/L   (normal: less than  59)
AST = 421    u/L   (normal: less than 81)
 
An ABDOMINAL ULTRASOUND was recommended to the owner and he agreed.  The summary of the ultrasound report is as follows:

1. Liver is moderately to severely enlarged with no tumours
2. Left and right adrenal glands have a nodule each in the cranial pole
3. Other organs are normal
4. No fluid inside the abdomen


More details are as follows:
THE ULTRASOUND  OF LIVER AND ADRENAL GLANDS

 LIVER - moderately to severely enlarged; borders are rounded but margins are smooth; echogenicity is diffusely increased; parenchyma is homogenous and no discrete masses or nodules are seen; vessel size is subjectively normal

Liver

Liver

ADRENAL GLANDS - one hyperechoic nodule present in cranial pole of both adrenal glands; margins are smooth and no signs of invasion of the blood vessels are seen.

 Right Adrenal Gland - nodule size of 1cm x 1.4cm

 Left Adrenal Gland - nodule size of 7.8mm x 9.7mm

 

Left Adrenal Gland - another view

THE OTHER ORGANS ARE NORMAL AS SHOWN BELOW.

 Gall Bladder - has gall bladder sludge (cholestasis); gall bladder wall is thin and moderately distended with bile; small amount of echogenic material is seen on the dependent wall; material dot have distal acoustic shadowing or a stellate appearance; no masses or stones are seen; no dilation of the cystic or common bile duct

 Right Kidney - normal; symmetrical in size; no cysts, masses, stones or dilations
4.1cm

 Right Kidney - another view

 Stomach- normal; wall layering normal without thickenings or masses
4.3mm

 Duodenum - normal; wall layering normal without thickenings or masses
3.6mm
Jejunum: 2.6mm
Ileum: 2mm

 Pancreas - both lobes appear normal with no edema, enlargement (1.4cm) or masses seen; no increase in echogenicity of the surrounding mesentery.

 Spleen - size is subjectively normal; shape is normal with a smooth capsule; parechyma is fine, homogenous and bright; no masses

 Left kidney - normal; symmetrical in size; no masses or stones present
4.5 cm

  Left kidney - another view

 Bladder - normal; no masses or stones present; thin-walled and moderately distended with anechoic urine

 

Bladder - another view

 Urethra - normal; urethral wall normal; no dilation

 Colon - normal; thin wall with no masses seen
1.8mm

Small Intestine - normal; wall layering normal with no thickenings or masses seen  

COMMENTS ABOUT ULTRASOUND
1. Fluid: No free fluid.
2. Lymph Nodes: No enlarged lymph nodes

DIFFERENTIAL DIAGNOSIS
1. PDH - Pituitary-dependent hyperadrenocorticism. The pituritary gland inside the brain is abnormal
2. Adrenal gland nodular hyperplasia or neoplasia or both. e.g. adenocarcinoma, phaechromocytoma
3. PDH or adrenal tumours or both? Measurement of endogenous plasma ACTH concentration is the reliable way to differentiate between PDH and adrenal tumour. ACTH is low or undetectable in adrenal tumour while it is normal to high in PDH.
4. Steroid hepatopathy - Liver disorder and disease due to endogenous or exogenous steroids.
5. Liver infection - chronic active hepatitis
6. Liver abnormality e.g. diffuse infiltrative liver disease or tumours
7. Diabetes mellitus
8. Diabetes insipidus
9. Unknown cause of increase/decrease of serum cortisone

ADVICES TO OWNER
1. Adrenal testing. Hyperadrenocorticism e.g. ACTH, low dose dexamethosone suppression (LLDS) test or high dose dexamethosone suppression (HDDS) test.
2. Treatment of PDH is with mitotane or tilostane.
3. Surgical removal of adrenal nodules/tumours if present. Abdominal ultrasonography is a more sensitive way to identify adrenal tumours or nodules, including liver metastasis or invasion into the vena cava blood vessel. 

4. Radiation   

PROGNOSIS
The owner has not decided what to do with the poodle. It has been reported that the maximum number of years a dog with hyperadrenocorticism can live is 2 years

CREDITS
Roxanna Neo Yuan Xin - Narrator; video editor

Dr Sing Kong Yuen - Veterinary surgeon
BVMS (Glasgow), MRCVS
Toa Payoh Vets
Consultant Vet @ Royal Asia Veterinary Surgery

Dr Daniel Sing - Veterinary surgeon
Toa Payoh Vets
BSc, BVMS (Murdoch)

FOR MORE VIDEOS, VISIT www.toapayohvets.com/videos.htm
FOR MORE INFORMATION, VISIT www.toapayohvets.com
Tel. No.: +65 62543326, 96686468
E-mail: judy@toapayohvets.com
Date: 1/7/2016

A video is created with the help of Raffles Institution Intern Roxanna Neo: