has the complete story.
Saturday, November 26, 2011
745. The "hidden" pup in canine Caesarean sections
http://www.sinpets.com/F5/20111126hidden-pup-caesarean-section-dog-singapore-toapayohvets.htm
has the complete story.
has the complete story.
Friday, November 25, 2011
744. Anaesthesia of old Chihuahua - vaginal hyperplasia and prolapse
Chihuahua, Female, 10 years
Active and eating well till 19.11.2011 when the owner noted a vaginal prolapsed. The dog became lethargic and did not eat. Vaginal or uterine prolapse diagnosed by Vet 1. Owner went back but the pushed back vaginal tissue came out again. Tip became black after 2 days. No e-collar worn.
22.11.11 A friend of the owner was worried and asked me to advise the owner to euthanase the Chihuahua if she was suffering from liver and kidney infections as deduced from abdominal ultrasound and blood test reports. I reviewed the case.
As the owner is not able to take care of the everted vaginal tissue and it had become necrotic, I advised spay the next day as this was the solution. But there was a high anaesthetic risk as the dog did not eat for the last 4 days and her tongue was purplish. Mild dehydration. Temperature below 38 deg C for the last 2 days.
22.11. 11 One day Pre-op IV drip and antibiotic
23.11. 11 37.6 deg, 3.5 kg.
10am
IV drip glucose 5 minutes, then dextrose saline. Tongue became pinker.
IV lasix 2 ml
Domitor 0.05 ml + Ketamine 0.05 ml IV
Isoflurane gas top up at 0.5 - 1%
I expected a 10-minute spay.
Dog vomited yellow liquid after intubation. Repeat.
Dog passed loose black stools. Cleaning up. This took time.
Opened abdomen, hooked out left ovary.
However, both the ovarian ligaments and bv ruptured when ligated. Bleeding seen. So, I had to make a large skin incision to locate the bleeder far inside, behind the kidneys. Two quail-egg sized blood clots on left and right sides were taken out. Bleeders located but bleeding was oozing now. Clamped and ligated one bleeder as the left one slipped off the kidney area. Checked and cleared all bleeding inside abdomen. Closed up 2/0 PDS sutures. Completion at 11.30 am.
Active and eating well till 19.11.2011 when the owner noted a vaginal prolapsed. The dog became lethargic and did not eat. Vaginal or uterine prolapse diagnosed by Vet 1. Owner went back but the pushed back vaginal tissue came out again. Tip became black after 2 days. No e-collar worn.
22.11.11 A friend of the owner was worried and asked me to advise the owner to euthanase the Chihuahua if she was suffering from liver and kidney infections as deduced from abdominal ultrasound and blood test reports. I reviewed the case.
As the owner is not able to take care of the everted vaginal tissue and it had become necrotic, I advised spay the next day as this was the solution. But there was a high anaesthetic risk as the dog did not eat for the last 4 days and her tongue was purplish. Mild dehydration. Temperature below 38 deg C for the last 2 days.
22.11. 11 One day Pre-op IV drip and antibiotic
23.11. 11 37.6 deg, 3.5 kg.
10am
IV drip glucose 5 minutes, then dextrose saline. Tongue became pinker.
IV lasix 2 ml
Domitor 0.05 ml + Ketamine 0.05 ml IV
Isoflurane gas top up at 0.5 - 1%
I expected a 10-minute spay.
Dog vomited yellow liquid after intubation. Repeat.
Dog passed loose black stools. Cleaning up. This took time.
Opened abdomen, hooked out left ovary.
However, both the ovarian ligaments and bv ruptured when ligated. Bleeding seen. So, I had to make a large skin incision to locate the bleeder far inside, behind the kidneys. Two quail-egg sized blood clots on left and right sides were taken out. Bleeders located but bleeding was oozing now. Clamped and ligated one bleeder as the left one slipped off the kidney area. Checked and cleared all bleeding inside abdomen. Closed up 2/0 PDS sutures. Completion at 11.30 am.
743. Day 3. Vaginal hyperplasia & prolapse in the female dog - Surgical option
Day 3. The Chihuahua bites me and my assistant any time we try to catch her. She does not eat but otherwise is alert and strong. "Is the vaginal prolapse the same size?" I asked my assistant Min, as part of my coaching process. I had pushed in the prolapse yesterday morning.
"Same as before," Min said. "Come out again." He could have difficulty understanding Singapore English as he is not proficient in this language.
He tried to muzzle the dog for me to examine. The dog snapped at him. I had taught him to use a towel to cover the dog's head but he did not do it this time. It needs lots of patience to train a person. I covered the dog's head with a towel. The dog moved to a corner. "Use a leash to lasso her," I said. Otherwise it is impossible to examine her. Min held the leash and lifted up the tail. The dog moved but could not bite us.
The prolapsed vagina had decreased by 60% in size. I was not surprised as spaying removed the oestrogen causing this problem. Min saw the size and that is important. I pushed it in. The dog should be able to go home soon as she is not eating here. I did advise a 20-ml syringe to feed her. A 2-ml syringe with canned food is too short.
"Same as before," Min said. "Come out again." He could have difficulty understanding Singapore English as he is not proficient in this language.
He tried to muzzle the dog for me to examine. The dog snapped at him. I had taught him to use a towel to cover the dog's head but he did not do it this time. It needs lots of patience to train a person. I covered the dog's head with a towel. The dog moved to a corner. "Use a leash to lasso her," I said. Otherwise it is impossible to examine her. Min held the leash and lifted up the tail. The dog moved but could not bite us.
The prolapsed vagina had decreased by 60% in size. I was not surprised as spaying removed the oestrogen causing this problem. Min saw the size and that is important. I pushed it in. The dog should be able to go home soon as she is not eating here. I did advise a 20-ml syringe to feed her. A 2-ml syringe with canned food is too short.
741. Severe tail injury - the sole option -- tail amputation
"There is only one option when the dog or cat suffers serious injury to its tail," I said to my associate vet who had stitched up the slanting tail laceration wound of more than 6 cm long and sent the dog home with e-collar and medication.
"Based on my past 30 years experience, many Singaporean dog and cat owners are not able to nurse their dog's tail wounds. Even with e-collars, the dog or cat hits the injured irritating tail, causing more damage. The tail does not heal and becomes gangrenous. The owner becomes upset as she had already spent money on this first surgical treatment. It is not working and now the owner is upset."
"In all tail injury cases, the owner must be advised firmly and in writing that tail amputation is the sole option as gangrene is likely to set in, with stitching and other bandaging. There was a case of a cat with tail injury. I advised tail amputation. We don't see any complaint post-op. Now, this case comes back with lots of unhappiness as the tail becomes blackened and the tip has become cold."
As the owner was unhappy with the outcome, I advise that she and the operating vet and myself meet at the same time to discuss the matter. It is best done that way than individuals giving their points of view to me one-on-one basis.
The outcome of a case of tail injury is very important to the owner. The owner wants just one visit and not be inconvenienced by having repeat treatment. "Even with gushing blood and copious bleeding, ligate the tail blood vessel, bandage the tail and amputate the tail 2 days later."
"Based on my past 30 years experience, many Singaporean dog and cat owners are not able to nurse their dog's tail wounds. Even with e-collars, the dog or cat hits the injured irritating tail, causing more damage. The tail does not heal and becomes gangrenous. The owner becomes upset as she had already spent money on this first surgical treatment. It is not working and now the owner is upset."
"In all tail injury cases, the owner must be advised firmly and in writing that tail amputation is the sole option as gangrene is likely to set in, with stitching and other bandaging. There was a case of a cat with tail injury. I advised tail amputation. We don't see any complaint post-op. Now, this case comes back with lots of unhappiness as the tail becomes blackened and the tip has become cold."
As the owner was unhappy with the outcome, I advise that she and the operating vet and myself meet at the same time to discuss the matter. It is best done that way than individuals giving their points of view to me one-on-one basis.
The outcome of a case of tail injury is very important to the owner. The owner wants just one visit and not be inconvenienced by having repeat treatment. "Even with gushing blood and copious bleeding, ligate the tail blood vessel, bandage the tail and amputate the tail 2 days later."
Thursday, November 24, 2011
741. Keratitis in pugs and people
Keratitis is an inflammation of the cornea. In people wearing soft contact lens, there are 3 types of keratitis:
1. Infective Keratitis. Cornea inflammation caused by micro-organisms like baceria, fungi and parasites. Can lose eye-sight if not treated early or by appropriate antibiotics. Cloudy scar on cornea when healed. A person can't see clearly. Same with pugs and other dogs. Big problem in pugs and shih tzus. It is called ulcerative keratitis. See one picture below:
2. Epthelial Keratitis. The top layer of the cornea is inflamed. Small holes are seen in the epithelium. It is called punctate epithelial erosions and this is also commonly seen in pugs and shih tzus. For the dogs, it is due to traumatic injury. See the green spots of one pug's eye below:
The holes may get infected by bacterial.
3. Allergic Conjunctivitis. The membrane which is below the eyelids is called conjunctiva. An allergic reaction to the contact lens or its solution leads to eyelid swelling and pain.
Chemosis - swelling of eyelids.
PUGS, SHIH TZUS AND PEKINESE
Ulcerative Keratitis is commonly seen due to injury to the protruding eyeball. Early treatment saves the eye sight.
Many Singapore owners of the pug and shih tzu and related breeds have no time to maintain the facial folds or damage the cornea during cleaning of the facial fold. Hairs get trapped inside the eyelids and as you can see from the picture below, the cornea is deprived of oxygen by the turfs of hair and get irritated and infected by bacteria found in the hairs.
My advice is to get your vet to excise both facial folds, preventing the formation of ulceratitive keratitis. But many Singapore owners do not want to accept this advice and so, as the years pass by, the cornea becomes blackened or browned by pigments (chronic irritation for many years). The dog is practicallly blind but the owner is not personally affected. It is just so sad. Keeping the eyes of pugs, shih tzus and pekineses clear and transparent to old age is a heavy responsibility. I hope the younger google generation will be more enlightened and sophisticated to prevent such problems by early treatment at the vet or by getting the facial fold excision done.
1. Infective Keratitis. Cornea inflammation caused by micro-organisms like baceria, fungi and parasites. Can lose eye-sight if not treated early or by appropriate antibiotics. Cloudy scar on cornea when healed. A person can't see clearly. Same with pugs and other dogs. Big problem in pugs and shih tzus. It is called ulcerative keratitis. See one picture below:
2. Epthelial Keratitis. The top layer of the cornea is inflamed. Small holes are seen in the epithelium. It is called punctate epithelial erosions and this is also commonly seen in pugs and shih tzus. For the dogs, it is due to traumatic injury. See the green spots of one pug's eye below:
3. Allergic Conjunctivitis. The membrane which is below the eyelids is called conjunctiva. An allergic reaction to the contact lens or its solution leads to eyelid swelling and pain.
Chemosis - swelling of eyelids.
PUGS, SHIH TZUS AND PEKINESE
Ulcerative Keratitis is commonly seen due to injury to the protruding eyeball. Early treatment saves the eye sight.
Many Singapore owners of the pug and shih tzu and related breeds have no time to maintain the facial folds or damage the cornea during cleaning of the facial fold. Hairs get trapped inside the eyelids and as you can see from the picture below, the cornea is deprived of oxygen by the turfs of hair and get irritated and infected by bacteria found in the hairs.
My advice is to get your vet to excise both facial folds, preventing the formation of ulceratitive keratitis. But many Singapore owners do not want to accept this advice and so, as the years pass by, the cornea becomes blackened or browned by pigments (chronic irritation for many years). The dog is practicallly blind but the owner is not personally affected. It is just so sad. Keeping the eyes of pugs, shih tzus and pekineses clear and transparent to old age is a heavy responsibility. I hope the younger google generation will be more enlightened and sophisticated to prevent such problems by early treatment at the vet or by getting the facial fold excision done.
--------------------------
22 Dec 2020. The lady owner of this 10-year-old male not neutered pug contacted me via text message as her pug's right eye had some "brown" thing. It was a matted cornea with ulcers and hair glued onto the cornea, on detailed examination, under sedation, in the operation room. Images are in instagram as well.
Monday, November 21, 2011
740. SOP Dental scaling at Toa Payoh Vets
The following is advised before an old dog (>5 years old) gets dental work done under general anaesthesia
1. General and detailed examination
2. Complete blood test for health screening
3. Oral antibiotics for 7 days before dental work
4. Dental work with low sedation and use of isoflurane + O2 gas
5. Post-op antibiotic and pain-killer injection
6. Post-op pain-killer and antibiotics 5 days
7. Teeth extracted to be shown to owner
8. Dental record
9. Dental reminder 2 years later
P.S. X-rays of lungs and heart ECG may need to be done
1. General and detailed examination
2. Complete blood test for health screening
3. Oral antibiotics for 7 days before dental work
4. Dental work with low sedation and use of isoflurane + O2 gas
5. Post-op antibiotic and pain-killer injection
6. Post-op pain-killer and antibiotics 5 days
7. Teeth extracted to be shown to owner
8. Dental record
9. Dental reminder 2 years later
P.S. X-rays of lungs and heart ECG may need to be done
A big thank you to the young Singaporeans who produced the following videos to educate pet owners and bring veterinary medicine and surgery alive to the vet students studying hard for their exam.
As these google-generation people are very busy and have not charged me for services, I have not asked them to edit again to make a perfect production.
The following are the videos:
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the Sec 3 St Andrew boys produced. The "owner" of the pug was the student but the other characters are genuine. The video producer was another student and his teacher had kindly recommended him to me to help in this production. It turned out to be quite fun to watch this video, in my opinion.
For example, locking the door of the black Mercedes car is not done nowadays but we all had great fun in producing this video. The "owner" seemed to be smiling when he came for a second vet visit with a puppy that had worsened in coughing! I mean, the real owner would be very worried!
After hospitalisation in a crate, there was a scene of the puppy on the consultation table inside the vet consultation room! This should be cut! This is the first video production and no more other versions. That is why I explained the "deficiencies" in the production!
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video - Nicole Pereira. Excellent summary of some of the main problems seen at Toa Payoh Vets. Great work.
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up - Temasek Polytechnic Vet Tech students who do not wish to be credited
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2 - Temasek Polytechnic Vet Tech students who do not wish to be credited
Overall, it took a lot of time. Too much time.
As these google-generation people are very busy and have not charged me for services, I have not asked them to edit again to make a perfect production.
The following are the videos:
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the Sec 3 St Andrew boys produced. The "owner" of the pug was the student but the other characters are genuine. The video producer was another student and his teacher had kindly recommended him to me to help in this production. It turned out to be quite fun to watch this video, in my opinion.
For example, locking the door of the black Mercedes car is not done nowadays but we all had great fun in producing this video. The "owner" seemed to be smiling when he came for a second vet visit with a puppy that had worsened in coughing! I mean, the real owner would be very worried!
After hospitalisation in a crate, there was a scene of the puppy on the consultation table inside the vet consultation room! This should be cut! This is the first video production and no more other versions. That is why I explained the "deficiencies" in the production!
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video - Nicole Pereira. Excellent summary of some of the main problems seen at Toa Payoh Vets. Great work.
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up - Temasek Polytechnic Vet Tech students who do not wish to be credited
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2 - Temasek Polytechnic Vet Tech students who do not wish to be credited
Overall, it took a lot of time. Too much time.
734. Educational videos produced by young Singaporeans for Toa Payoh Vets
E-MAIL FROM DR SING DATED NOV 21, 2011
Thank you very much for your help in producing the Responsible Pet video meant for the AVA Responsible Dog Ownership Road show. The KC video was also good thanks to your help. The voices of the narrators were distinct and clear, to my surprise and the narrative scenes were not boring unlike a power point presentation or a professor's lecture. I hope the vet students do learn a bit about complicated kennel cough.
I gave each party general guidelines as I want other views and presentation.
Each party brings in something new (ideas and presentation and music) in video production and that is why it is so interesting to watch them. Thanks again.
I am only worried about the microchip scanning pic and some other pic you put on the Responsible Pet Ownership video as they may be copyright. Pl confirm the source as we can get sued or get a legal warning to remove it! Pl look into this matter and it is best to remove them and put in original images.
On Sun, Nov 20, 2011 at 5:06 PM, Nicole Pereira wrote:
Hi Dr Sing, here's the links to the videos i uploaded to your 99pups account-
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the St Andrew boys produced
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2
Thank you very much for your help in producing the Responsible Pet video meant for the AVA Responsible Dog Ownership Road show. The KC video was also good thanks to your help. The voices of the narrators were distinct and clear, to my surprise and the narrative scenes were not boring unlike a power point presentation or a professor's lecture. I hope the vet students do learn a bit about complicated kennel cough.
I gave each party general guidelines as I want other views and presentation.
Each party brings in something new (ideas and presentation and music) in video production and that is why it is so interesting to watch them. Thanks again.
I am only worried about the microchip scanning pic and some other pic you put on the Responsible Pet Ownership video as they may be copyright. Pl confirm the source as we can get sued or get a legal warning to remove it! Pl look into this matter and it is best to remove them and put in original images.
On Sun, Nov 20, 2011 at 5:06 PM, Nicole Pereira
Hi Dr Sing, here's the links to the videos i uploaded to your 99pups account-
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the St Andrew boys produced
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2
Sunday, November 20, 2011
Sunday Nov 20, 2011 interesting cases
EYES
1. Pug with right eye perforated ulcer treated by me some months ago came in for annual vaccination. A young couple who remembered me as much as I remember them due to this serious eye injury drama as described in my case:
Ulcer healed very well but two very small green ulcers (fluorescein stain) seen to the 7 o'clock. Extraordinary amount of hairs clumped together on corneal surface when I cleaned it (see image). Dr Vanessa had applied the fluroescein strip and had flushed out the green dye. I took over while she checked another dog as the couple wanted to consult me.
Left eye - no ulcers but brown pigmentation covers 50$% of central area - friction from owner cleaning facial fold daily?
I advised facial fold excision as the hairs from the fold must have irritaed the corena (central area) and the pug must be rubbing the eye. "Alternative is to close the eyelids when cleaning the facial fold area," I said.
"Will the surgery affect the health of the pug?" the lady asked. "No," I said. Less itchiness and no more need to wipe the secretions off the facial fold. If irritation continues, the cornea will be seeded by brown black pigments over the years and the dog can't see clearly in front.
The owners would think about the surgery. Their other pug has no corneal ulceration problems. It is hard to foresee the future. "The facial fold is part of the pug's beauty but healthy is more important than beauty," I said.
2. CORNEAL DYSTROPHY
The miniature pinscher owner had texted to consult me yesterday to review the eye. She firmly believes that the circle of whiteness of the inside of the cornea had been reduced with the use of garasone eye drops daily with one small drop.
I will refer to the other picture I took some time ago and see. It seems that the circle has shrunk a bit and the edges are more firm. I need to review the old pic.
The left eye has some interesting developments when I view the images. The dog was fidgety and therefore no proper examination was possible. The owner did not want fluroescein eye stain test for the eyes and so I can't confirm whether the left eye still has ulcers in the upper half near the melanomas.
The pic traken toaday shows "crocodile skin" areound the eyelids. Must check previous pic soon.
CASE 3
A 13-year-old pug passed away after 11 pm yesterday. My assistant Min saw him alive and resting at 11 pm when he did his last checking.
"Why did you send a pug for grooming?" I asked the young couple who told me that the pug had never coughed once before going to the groomer two days ago (Friday). Then she coughed vigorously at home for a long time and so I was consulted on Saturday morning. The pug did not cough when I saw him. "The likely cause of coughing is due to kennel cough," I said as kennel cough is a common disease in places where dogs of various ages mix and it is a very contagious disease. The old dog had not been vaccinated forl many years. So, the primary diagnosis was kennel cough - a dry hacking cough.
I recommended to ward the old dog in a cage so she could rest. "Continuous coughing will result in blood vessel rupture in the lungs," I said to the young couple. Blood test was advised to check for infectious situation but the owners declined.
When the pug died, both her nostrils had red blood. Her tongue was cyanotic. So there was some respiratory damage and bleeding. "An independent post-mortem by the AVA will be needed to ascertain the cause of death," I said to the lady whom I phoned. "The dog is old and her immune system would be weak and she was not able to fight off the viruses and bacteria of kennel cough," I said. Cremation was arranged and the urn would be available in 2 days' time. It is one of the cases where old dogs without vaccination should not be exposed to other dogs. The pug was having her nails clipped and she panted at the pet shop. It was a sad Sunday for me as the pug had not shown any signs of impending death at the Surgery. In fact he had eaten some food after treatment with antibiotics and a drip. However, I had warned the owner of a possible death and the owners were understanding.
1. Pug with right eye perforated ulcer treated by me some months ago came in for annual vaccination. A young couple who remembered me as much as I remember them due to this serious eye injury drama as described in my case:
Ulcer healed very well but two very small green ulcers (fluorescein stain) seen to the 7 o'clock. Extraordinary amount of hairs clumped together on corneal surface when I cleaned it (see image). Dr Vanessa had applied the fluroescein strip and had flushed out the green dye. I took over while she checked another dog as the couple wanted to consult me.
Left eye - no ulcers but brown pigmentation covers 50$% of central area - friction from owner cleaning facial fold daily?
I advised facial fold excision as the hairs from the fold must have irritaed the corena (central area) and the pug must be rubbing the eye. "Alternative is to close the eyelids when cleaning the facial fold area," I said.
"Will the surgery affect the health of the pug?" the lady asked. "No," I said. Less itchiness and no more need to wipe the secretions off the facial fold. If irritation continues, the cornea will be seeded by brown black pigments over the years and the dog can't see clearly in front.
The owners would think about the surgery. Their other pug has no corneal ulceration problems. It is hard to foresee the future. "The facial fold is part of the pug's beauty but healthy is more important than beauty," I said.
2. CORNEAL DYSTROPHY
The miniature pinscher owner had texted to consult me yesterday to review the eye. She firmly believes that the circle of whiteness of the inside of the cornea had been reduced with the use of garasone eye drops daily with one small drop.
I will refer to the other picture I took some time ago and see. It seems that the circle has shrunk a bit and the edges are more firm. I need to review the old pic.
The left eye has some interesting developments when I view the images. The dog was fidgety and therefore no proper examination was possible. The owner did not want fluroescein eye stain test for the eyes and so I can't confirm whether the left eye still has ulcers in the upper half near the melanomas.
The pic traken toaday shows "crocodile skin" areound the eyelids. Must check previous pic soon.
CASE 3
A 13-year-old pug passed away after 11 pm yesterday. My assistant Min saw him alive and resting at 11 pm when he did his last checking.
"Why did you send a pug for grooming?" I asked the young couple who told me that the pug had never coughed once before going to the groomer two days ago (Friday). Then she coughed vigorously at home for a long time and so I was consulted on Saturday morning. The pug did not cough when I saw him. "The likely cause of coughing is due to kennel cough," I said as kennel cough is a common disease in places where dogs of various ages mix and it is a very contagious disease. The old dog had not been vaccinated forl many years. So, the primary diagnosis was kennel cough - a dry hacking cough.
I recommended to ward the old dog in a cage so she could rest. "Continuous coughing will result in blood vessel rupture in the lungs," I said to the young couple. Blood test was advised to check for infectious situation but the owners declined.
When the pug died, both her nostrils had red blood. Her tongue was cyanotic. So there was some respiratory damage and bleeding. "An independent post-mortem by the AVA will be needed to ascertain the cause of death," I said to the lady whom I phoned. "The dog is old and her immune system would be weak and she was not able to fight off the viruses and bacteria of kennel cough," I said. Cremation was arranged and the urn would be available in 2 days' time. It is one of the cases where old dogs without vaccination should not be exposed to other dogs. The pug was having her nails clipped and she panted at the pet shop. It was a sad Sunday for me as the pug had not shown any signs of impending death at the Surgery. In fact he had eaten some food after treatment with antibiotics and a drip. However, I had warned the owner of a possible death and the owners were understanding.
736. Health of Westie
The Westie Foundation of Amercia - health matters funded.
Atopic dermatitits (an allergice skin disease)
Bladder cancer
Idiopathic pulmonary fibrosis (lung scars)
Copper toxicity (hepatitis & liver failure)
Legg-Calve-Perthes disease (hip joint degenerative disease)
Luxating patellas (dislocating knee caps)
Addison's disease
Inflammatory bowel disease
Cataract
Dry eye (keratoconjunctivitis sicca)
Cranio-mandibular osteopathy (painful bone growths in the skull and jaw b ut usually OK by 12 months of age)
White shaker dog syndrome (entire body shakes or trembles - appear in other small white breeds - immune system disorder suspected - successfully treated with steroids).
Atopic dermatitits (an allergice skin disease)
Bladder cancer
Idiopathic pulmonary fibrosis (lung scars)
Copper toxicity (hepatitis & liver failure)
Legg-Calve-Perthes disease (hip joint degenerative disease)
Luxating patellas (dislocating knee caps)
Addison's disease
Inflammatory bowel disease
Cataract
Dry eye (keratoconjunctivitis sicca)
Cranio-mandibular osteopathy (painful bone growths in the skull and jaw b ut usually OK by 12 months of age)
White shaker dog syndrome (entire body shakes or trembles - appear in other small white breeds - immune system disorder suspected - successfully treated with steroids).
Friday, November 18, 2011
735. Inspirational picture
MESSAGE TO AN ENTREPRENEUR
As regards your water project, I am reminded of this martial arts movie "Dead Or Alive" which is free online and just watched by me as I do my early morning internet work. In the movie, the antagonist mentioned 3 words about the Japanese lady not up to the mark as her brother. She needs "Skills, Timing and Strength" but she has no "strength".
Somehow, these 3 words seem apt for your project in wanting to expand your business from Singapore to China and Indonesia. I was wondering what to write in a picture of flowers I just took last Saturday at Sentosa. Now, I know and I produce a picture to encourage you.
1. The timing is right (environmental health concern for clean water), the skill is there (your brother) but the strength (of the parties doing marketing) is to be established and you have got the expatriate
and others you are networking to build up a team to increase your strength.
2. Thinking of making money all the time will not make one be successful in business, in my opinion.
As regards your water project, I am reminded of this martial arts movie "Dead Or Alive" which is free online and just watched by me as I do my early morning internet work. In the movie, the antagonist mentioned 3 words about the Japanese lady not up to the mark as her brother. She needs "Skills, Timing and Strength" but she has no "strength".
Somehow, these 3 words seem apt for your project in wanting to expand your business from Singapore to China and Indonesia. I was wondering what to write in a picture of flowers I just took last Saturday at Sentosa. Now, I know and I produce a picture to encourage you.
1. The timing is right (environmental health concern for clean water), the skill is there (your brother) but the strength (of the parties doing marketing) is to be established and you have got the expatriate
and others you are networking to build up a team to increase your strength.
2. Thinking of making money all the time will not make one be successful in business, in my opinion.
Thursday, November 17, 2011
734. SOP - Lameness in a Golden Retriever
Thursday, Nov 17, 2011
9.30 am
I usually consult from 9.30 am to 11 am.
A lady owner and two friends consulted me for a 2nd opinion as regards her 9-month-old male Golden Retriever. born Feb 2011, limping on right hind for the last few weeks. Vet 1 had been consulted earlier regarding some skin disease.
Below are my Standard Operating Procedures for examination of canine lameness at Toa Payoh Vets for this case as a real case example as it is easier for reader to understand. Basically it is similar to examination of a lame horse.
1. HISTORY OF LAMENESS - Right Hind lamenss
Purchase - 3 months old from a Pasir Ris breeder
Onset - RH lame seen at 7th month
Duration - 2 months
Further questioning: The puppy does not jump up or down car and does not hop down stairs since purchase. Pain in hip and other joints likely to be present before purchase as most normal puppies will do the jumping.
2. LAMENESS EXAMINATION - Outside the Surgery. As in the racehorse lameness exam.
2.1 Walk
2.2 Trot
2.3 Turn
Limping on right hind obvious as the dog did not put weight on this leg and the left hind hip dipped on trotting.
3. PUT ON EXAMINATION TABLE - Do not examine on the floor!
3.1 Pain check of dog standing esp. spinal area. Spinal T5-L5 slightly painful.
3.2 Pain check by palpation of joints with dog lying down sideways on the table.
Slight pain on extension of right hip and right knee.
3.3 Dog recumbent on right side. Extend and flex all joints vigorously. The owners were worried about my vigorous manipulations but the dog did not react since he had no pain from the extensions and flexions. Some vets do gentle manipulations and mis-diagnose.
3.4 Dog standing on table. Compare length of right and left hind limb by extension and show to the owner the lengths of two hind limbs. In this case, the owner could see that the riight hind was noticeably shorter by 2-4 cm. Subluxation? Mild pain only. To X-ray both hip joints later.
3.5 There are other reflexes to be checked if the dog is paralysed but in this case, it is not. Refer to your neurological exam book.
4. TENTATIVE DIAGNOSIS
Right hip dysplasia likely as this condition is better shown at the 9th - 12th month than as a young pup. To X-ray hip joints at a later date.
5. ADVICES
5.1 No weight gain throughout his life, thereby avoiding surgery
5.2 No slopes or stair climbing or jumping from sofas etc
6. SKIN DISEASE. A separate case study and procedure which will not be written up here. Generalised pustular dermatitis, elbow and hock sores. Dog likes to sleep on wet floors. Anal sacculitis (pink hairless areas below anus pointed out by the owner). Rashes seen on elbows and hock area pigmentation suggested licking and early onset of elbow and hock sores. Preventive measures including moisturers for a time. The owner asked for Neoderm cream. No cream advised by me as the hair will not grow if the cream is used for a long time.
Best is daily grooming and inspection of the coat for this Golden Retriever and know where the "hot spots" will occur. Dog is clipped bald. Generally, the skin infections are due to bacteria but the vet cannot rule out ringworm and demodectic mites. Vet 1 had scraped skin and found no mites but there was no medical report given to the owner.
9.30 am
I usually consult from 9.30 am to 11 am.
A lady owner and two friends consulted me for a 2nd opinion as regards her 9-month-old male Golden Retriever. born Feb 2011, limping on right hind for the last few weeks. Vet 1 had been consulted earlier regarding some skin disease.
Below are my Standard Operating Procedures for examination of canine lameness at Toa Payoh Vets for this case as a real case example as it is easier for reader to understand. Basically it is similar to examination of a lame horse.
1. HISTORY OF LAMENESS - Right Hind lamenss
Purchase - 3 months old from a Pasir Ris breeder
Onset - RH lame seen at 7th month
Duration - 2 months
Further questioning: The puppy does not jump up or down car and does not hop down stairs since purchase. Pain in hip and other joints likely to be present before purchase as most normal puppies will do the jumping.
2. LAMENESS EXAMINATION - Outside the Surgery. As in the racehorse lameness exam.
2.1 Walk
2.2 Trot
2.3 Turn
Limping on right hind obvious as the dog did not put weight on this leg and the left hind hip dipped on trotting.
3. PUT ON EXAMINATION TABLE - Do not examine on the floor!
3.1 Pain check of dog standing esp. spinal area. Spinal T5-L5 slightly painful.
3.2 Pain check by palpation of joints with dog lying down sideways on the table.
Slight pain on extension of right hip and right knee.
3.3 Dog recumbent on right side. Extend and flex all joints vigorously. The owners were worried about my vigorous manipulations but the dog did not react since he had no pain from the extensions and flexions. Some vets do gentle manipulations and mis-diagnose.
3.4 Dog standing on table. Compare length of right and left hind limb by extension and show to the owner the lengths of two hind limbs. In this case, the owner could see that the riight hind was noticeably shorter by 2-4 cm. Subluxation? Mild pain only. To X-ray both hip joints later.
3.5 There are other reflexes to be checked if the dog is paralysed but in this case, it is not. Refer to your neurological exam book.
4. TENTATIVE DIAGNOSIS
Right hip dysplasia likely as this condition is better shown at the 9th - 12th month than as a young pup. To X-ray hip joints at a later date.
5. ADVICES
5.1 No weight gain throughout his life, thereby avoiding surgery
5.2 No slopes or stair climbing or jumping from sofas etc
6. SKIN DISEASE. A separate case study and procedure which will not be written up here. Generalised pustular dermatitis, elbow and hock sores. Dog likes to sleep on wet floors. Anal sacculitis (pink hairless areas below anus pointed out by the owner). Rashes seen on elbows and hock area pigmentation suggested licking and early onset of elbow and hock sores. Preventive measures including moisturers for a time. The owner asked for Neoderm cream. No cream advised by me as the hair will not grow if the cream is used for a long time.
Best is daily grooming and inspection of the coat for this Golden Retriever and know where the "hot spots" will occur. Dog is clipped bald. Generally, the skin infections are due to bacteria but the vet cannot rule out ringworm and demodectic mites. Vet 1 had scraped skin and found no mites but there was no medical report given to the owner.
Tuesday, November 15, 2011
733. Kennel cough follow-up by text message
The young generation prefers to text but it is not good when it comes to your pug's illness as illustrated in the following case.
Nov 13, 2011 10.59 am
Good morning Dr Sing.This is ... the owner of Zorro (Pug). We visited your cllinic on 8th. My puppy was having kennel cough and runny nose. He used to eat well and was active but this morning, he is not having any food and keeps on sleeping. When he walks, he has difficulty walking due to heavy coughing. So he walks a bit and then just sits down and he is not active anymore. Antibiotic has not been finished yet but since he seems not well, should I bring him back to the clinic?
It would be much appreciated if you could reply to my sms
Nov 13, 2011 12.04 pm
Pl tel me
NO REPLY. I PHONED. NO REPONSE.
Nov 13, 2011 9.31 pm
Dr Sing, I really need your help now with my pug. For all day, he rarely moved and seems no energy with him. Is there any chance we can bring him for emergency now?
I PHONED THE OWNER. As the pug was ok, I advised giving him a teaspoonful of honey + water and bring back to the clinic at 10 am on Nov 14.
On examination, the pug had copious amounts of nasal discharge. Difficulty in breathing. Some lung sounds, but no fever. I gave treatment and cough mixture.
"It is not possible to cage him 100% at home," I had advised the couple who brought the pug to me for examination one day after purchase on Nov 8.
"Play with the pug for only 5 minutes after meals which were given twice a day," I had advised. "Kennel cough is caused by virus and bacteria. Viral diseases do not have antibiotics but resting the puppy by confinement strictly in a cage will help speed recovery. Some cases take up to 3 weeks to recover."
In this case, the pug had space to run around as all puppies take advantage of freedom at a new house. He also hated taking medicine as he fought me when I syringe him 0.05 ml of the cough mixture.
"It is difficult to give him medicine by mouth," the young man said. "My pug rests his head on a soft toy," the gentleman said.
"Puppies do that when they can't breathe properly," I said. I rolled up a towel like a small pillow. The pug rested his neck on the edge of the pillow. Eyes bright but he was tired.
"Can we visit him for 15 minutes?" the gentleman asked.
"Yes," I said. "But this pug must be inside the cage for the next 2-3 days to rest." The couple came at 7 pm on the same day. Nursing, feeding, electrolytes and observation are made every 2 hourly to ensure that the pug is OK.
Nov 13, 2011 10.59 am
Good morning Dr Sing.This is ... the owner of Zorro (Pug). We visited your cllinic on 8th. My puppy was having kennel cough and runny nose. He used to eat well and was active but this morning, he is not having any food and keeps on sleeping. When he walks, he has difficulty walking due to heavy coughing. So he walks a bit and then just sits down and he is not active anymore. Antibiotic has not been finished yet but since he seems not well, should I bring him back to the clinic?
It would be much appreciated if you could reply to my sms
Nov 13, 2011 12.04 pm
Pl tel me
NO REPLY. I PHONED. NO REPONSE.
Nov 13, 2011 9.31 pm
Dr Sing, I really need your help now with my pug. For all day, he rarely moved and seems no energy with him. Is there any chance we can bring him for emergency now?
I PHONED THE OWNER. As the pug was ok, I advised giving him a teaspoonful of honey + water and bring back to the clinic at 10 am on Nov 14.
On examination, the pug had copious amounts of nasal discharge. Difficulty in breathing. Some lung sounds, but no fever. I gave treatment and cough mixture.
"It is not possible to cage him 100% at home," I had advised the couple who brought the pug to me for examination one day after purchase on Nov 8.
"Play with the pug for only 5 minutes after meals which were given twice a day," I had advised. "Kennel cough is caused by virus and bacteria. Viral diseases do not have antibiotics but resting the puppy by confinement strictly in a cage will help speed recovery. Some cases take up to 3 weeks to recover."
In this case, the pug had space to run around as all puppies take advantage of freedom at a new house. He also hated taking medicine as he fought me when I syringe him 0.05 ml of the cough mixture.
"It is difficult to give him medicine by mouth," the young man said. "My pug rests his head on a soft toy," the gentleman said.
"Puppies do that when they can't breathe properly," I said. I rolled up a towel like a small pillow. The pug rested his neck on the edge of the pillow. Eyes bright but he was tired.
"Can we visit him for 15 minutes?" the gentleman asked.
"Yes," I said. "But this pug must be inside the cage for the next 2-3 days to rest." The couple came at 7 pm on the same day. Nursing, feeding, electrolytes and observation are made every 2 hourly to ensure that the pug is OK.
Sunday, November 13, 2011
731. Animal Welfare Activists
On Mon, Sep 5, 2011 at 12:39 PM, ...@gmail.com> wrote:
Attention to the Veterinary Head of Toa Payoh Vets,
My name is ... and I am working full time for a church in Singapore.
Our church is currently in the process of getting a new animal shelter set up in Singapore. We are waiting for tenders from AVA or SLA for dog farms in Sungei Tengah. The shelter should be up and going in about 1 or 2 year's time. Our emphasis will specifically be to help stray or abandoned dogs. We are serious about this ministry and is looking forward toward setting it up as soon as possible.
The reason for writing to you is to ask if your clinic would be be interested to participate in the sterilization, vaccination and medical treatment program of our dogs.
We hope that you could partner with us in this good cause.
If so, please let us know how much you will charge us (roughly) for the following services so that we can better estimate our financial planning. We would greatly appreciate if you could give us a subsidized rate that is lower than the market.
Vaccination of a dog (regardless of size & inclusive of medication)
Sterilization of a dog (regardless of size & inclusive of medication)
Microchipping
Consultation fee
Medication discount
Essential Products such as heartguard, frontline
Medicated shampoos
Hope to hear from you soon. Thank you.
Alternatively, if any of your vets are interested to help on an individual, voluntary or private basis, please also respond to me.
God bless you,
...
On Mon, Sep 5, 2011 at 4:00 PM, Kelly Lim wrote:
Dear Dr Sing
Thank you for your prompt reply. We will contact you again when we have the latest update.
God bless you,
....
E-MAIL REPLY FROM DR SING DATED SEP 5, 2011
I am Dr Sing. As there is inflation and prices go up yearly, it is not possible to quote now and there will be misunderstandings when your shelter is built in 2-4 years' s time. Please let me know when the tender has been successful.
E-MAIL TO DR SING DATED NOV 11, 2011
On Fri, Nov 11, 2011 at 10:40 AM, ...gmail.com> wrote:
Dear Dr Sing
I am .., who have previously communicated with you over a few emails regarding our church's planned shelter for stray dogs. We have confirmed with AVA about the timing of the tender. It will probably be open only in 2013.
However, in the meanwhile, we can't just sit and wait for the land to come and ignore the terrible plight of the stray dogs. For the past 2 years, a few of us have already been feeding about 70 strays here and there, as well as actively putting up adoption for the puppies. We have our puppies screened for parvo virus, vaccinated & dewormed before giving them away for adoption. For the grown dogs, we have also got a few happily adopted. So far they are all success stories. We also sterilize the females. Many of them are sterilized except for about 10 more because they are very smart. Yet 10 females can reproduce beyond what we can cope. Still trying our best to patiently gain their trust.
Occasionally tragedies still happen. This year, we lost 2 batches of 8-9 puppies (could not catch them in time when they were about 5 weeks old and started running around in the open) that were in one night swept by the China and Thai workers for their "makan". These workers usually congregate over weekends and that is when they will notice the puppies and gang up to catch all of them.
Recently 1 black mongrel puppy was kicked to death at 3 month old and the other one blinded by the impact but a miracle happened and his eyesight is restored. Now he is in a foster home. They were the only ones left un-adopted because they were black in color.
So far I have visited ... and .... They do have 10% discount for strays but the bills still come up to an exorbitant amount for so many dogs.
Would you be able to propose a medical service package for us during these 2 years of transition before our shelter is formally up?
Looking forward to your reply.
God bless you,
...
E-MAIL REPLY DATED NOV 13, 2011
I am sorry I can't help you as my clinic is very small with 1 full-time vet, unlike ... and ... and other clinics who have many vets. In any case, I advise you to contact the newer clinics (there are over 40 clinics) in Singapore and these may be able to help you. You just need to do so personally. E-mails save time but not so good if you want to be an activist.
Attention to the Veterinary Head of Toa Payoh Vets,
My name is ... and I am working full time for a church in Singapore.
Our church is currently in the process of getting a new animal shelter set up in Singapore. We are waiting for tenders from AVA or SLA for dog farms in Sungei Tengah. The shelter should be up and going in about 1 or 2 year's time. Our emphasis will specifically be to help stray or abandoned dogs. We are serious about this ministry and is looking forward toward setting it up as soon as possible.
The reason for writing to you is to ask if your clinic would be be interested to participate in the sterilization, vaccination and medical treatment program of our dogs.
We hope that you could partner with us in this good cause.
If so, please let us know how much you will charge us (roughly) for the following services so that we can better estimate our financial planning. We would greatly appreciate if you could give us a subsidized rate that is lower than the market.
Vaccination of a dog (regardless of size & inclusive of medication)
Sterilization of a dog (regardless of size & inclusive of medication)
Microchipping
Consultation fee
Medication discount
Essential Products such as heartguard, frontline
Medicated shampoos
Hope to hear from you soon. Thank you.
Alternatively, if any of your vets are interested to help on an individual, voluntary or private basis, please also respond to me.
God bless you,
...
On Mon, Sep 5, 2011 at 4:00 PM, Kelly Lim
Dear Dr Sing
Thank you for your prompt reply. We will contact you again when we have the latest update.
God bless you,
....
E-MAIL REPLY FROM DR SING DATED SEP 5, 2011
I am Dr Sing. As there is inflation and prices go up yearly, it is not possible to quote now and there will be misunderstandings when your shelter is built in 2-4 years' s time. Please let me know when the tender has been successful.
E-MAIL TO DR SING DATED NOV 11, 2011
On Fri, Nov 11, 2011 at 10:40 AM, ...gmail.com> wrote:
Dear Dr Sing
I am .., who have previously communicated with you over a few emails regarding our church's planned shelter for stray dogs. We have confirmed with AVA about the timing of the tender. It will probably be open only in 2013.
However, in the meanwhile, we can't just sit and wait for the land to come and ignore the terrible plight of the stray dogs. For the past 2 years, a few of us have already been feeding about 70 strays here and there, as well as actively putting up adoption for the puppies. We have our puppies screened for parvo virus, vaccinated & dewormed before giving them away for adoption. For the grown dogs, we have also got a few happily adopted. So far they are all success stories. We also sterilize the females. Many of them are sterilized except for about 10 more because they are very smart. Yet 10 females can reproduce beyond what we can cope. Still trying our best to patiently gain their trust.
Occasionally tragedies still happen. This year, we lost 2 batches of 8-9 puppies (could not catch them in time when they were about 5 weeks old and started running around in the open) that were in one night swept by the China and Thai workers for their "makan". These workers usually congregate over weekends and that is when they will notice the puppies and gang up to catch all of them.
Recently 1 black mongrel puppy was kicked to death at 3 month old and the other one blinded by the impact but a miracle happened and his eyesight is restored. Now he is in a foster home. They were the only ones left un-adopted because they were black in color.
So far I have visited ... and .... They do have 10% discount for strays but the bills still come up to an exorbitant amount for so many dogs.
Would you be able to propose a medical service package for us during these 2 years of transition before our shelter is formally up?
Looking forward to your reply.
God bless you,
...
E-MAIL REPLY DATED NOV 13, 2011
I am sorry I can't help you as my clinic is very small with 1 full-time vet, unlike ... and ... and other clinics who have many vets. In any case, I advise you to contact the newer clinics (there are over 40 clinics) in Singapore and these may be able to help you. You just need to do so personally. E-mails save time but not so good if you want to be an activist.
Thursday, November 10, 2011
730. AVA Reponsible Pet Ownership Roadshow 2011 - Toa Payoh Vets
TOA PAYOH VETS
Block 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074
6254-3326, 9668-6469, judy@toapayohvets.com, www.toapayohvets.com
Speaker: Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Founder & Practising Veterinarian, Toa Payoh Vets
Saturday, November 12, 2011
Nov 10, 2011
AVA Responsible Pet Ownership Roadshow 2011
Saturday, November 12, 2011, 1.30 pm - 2 pm, Changi Expo
"SOME COMMON DISEASES IN DOGS"
I accepted two slots on Saturday and Sunday to present a talk on dogs and hamsters respectively. However, the AVA cancelled my Sunday talk scheduled from 3.30 pm to 4 pm and offered me another slot at 1.30 pm. I am unable to take up this slot.
Therefore, I will talk about common diseases in hamsters on this Saturday as dwarf hamsters are quite popular with Singaporeans.
In short, I will be presenting some health care cases mainly in dogs. However, the responsibilities of health care and ownership in canine cases apply to the care of cats, hamsters and rabbits.
I apologise for the inconvenience caused to the audience who expect only canine matters to be presented.
As Power Point slide presentations of "Responsible Pet Ownership" can be extremely dull and sleep-inducing in my experience, I have just got videos produced and hope all of you will enjoy the stories based on some common real life cases encountered at Toa Payoh Vets. The stories cover some common cases seen at Toa Payoh Vets from the birth to old age of the pets from around 1980 to 2011.
If you have any questions about responsible pet ownership as regards health care matters or the the cases in the videos, some details are available at www.toapayohvets.com.
If not, tel me at the Surgery at 6254-3326, 9668-6469 or e-mail judy@toapayohvets.com
Block 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074
6254-3326, 9668-6469, judy@toapayohvets.com, www.toapayohvets.com
Speaker: Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Founder & Practising Veterinarian, Toa Payoh Vets
Saturday, November 12, 2011
Nov 10, 2011
AVA Responsible Pet Ownership Roadshow 2011
Saturday, November 12, 2011, 1.30 pm - 2 pm, Changi Expo
"SOME COMMON DISEASES IN DOGS"
I accepted two slots on Saturday and Sunday to present a talk on dogs and hamsters respectively. However, the AVA cancelled my Sunday talk scheduled from 3.30 pm to 4 pm and offered me another slot at 1.30 pm. I am unable to take up this slot.
Therefore, I will talk about common diseases in hamsters on this Saturday as dwarf hamsters are quite popular with Singaporeans.
In short, I will be presenting some health care cases mainly in dogs. However, the responsibilities of health care and ownership in canine cases apply to the care of cats, hamsters and rabbits.
I apologise for the inconvenience caused to the audience who expect only canine matters to be presented.
As Power Point slide presentations of "Responsible Pet Ownership" can be extremely dull and sleep-inducing in my experience, I have just got videos produced and hope all of you will enjoy the stories based on some common real life cases encountered at Toa Payoh Vets. The stories cover some common cases seen at Toa Payoh Vets from the birth to old age of the pets from around 1980 to 2011.
If you have any questions about responsible pet ownership as regards health care matters or the the cases in the videos, some details are available at www.toapayohvets.com.
If not, tel me at the Surgery at 6254-3326, 9668-6469 or e-mail judy@toapayohvets.com
Wednesday, November 9, 2011
729. Right ear weeping in a Westie - an unusual case
"I have seen 3 vets. One of them said there might be a tumour inside the right ear," the young lady said to me. "The last vet advised ear surgery." From my impressions, the young couple wanted a permanent solution to this one-year problem of the Westie with the itchy right ear and they came to see me.
This dog had lots of "water" inside the ear canal. I palpated the right ear. There was some pain as the dog moved his head away. But not great pain. As I pressed the ear, more "watery" discharge come out. As I cleared the discharge with a piece of tissue and then pressed the ear, more "watery" discharge comes out. Not those thick yellow pus, but watery. Why?
It was as if the horizontal ear canal was a deep well with lots of water. "Did your father apply the commercial ear drops recently?" I asked.
"No," the young lady said. "No more ear drops left."
This was a most unusual case. It was as if there was "underground" water.
"This ear needed to be irrigated," I advised.
I collaborate with Dr Vanessa on this case as part of my mentorship and succession program for Toa Payoh Vets.
Each young vet has his or her own idea of treatment and I wanted to make sure that this dog had a treatment that I would be doing and to maintain a standard of care that would be satisfactory to dog owners who come to Toa Payoh Vets for second or more opinions.
TREATMENT
Domitor IV sedated the dog partly. Muzzled. Dr Vanessa put in the pink antiseptic solution into the ear canal, massaged it to clear the debri. That is the standard way and that would be what the other vets had been doing. Nothing wrong with that.
But it might not be effective compared to ear irrigation.
So I intervened and demonstrated how the ear irrigation ought to be done. There is a technique. I had shown this in my video at:
http://www.youtube.com/watch?v=xhZ5eGJdwnY
Dr Vanessa used the 20-ml syringe to flush the ear. "You need to exercise your thumb muscles," I said as she injected the water into the ear without much force. "The irrigation angle has to be at 45 degrees to the horizontal canal and with speed," I demonstrated. It is easier said and demonstrated than done.
White tissue pieces from the walls of the vertical canal came out. Large extensive ulcers. As I irrigated more, a small piece of brown tissue came out. Then a few more brown bits. Strange. No pus.
I left the room to talk to the couple. Then I returned to the room to continue working with Dr Vanessa. She had extracted a big amount of brownish fibres from deep inside the ear. Good work. "What are these brown stuff?" I asked her.
"It could be tumours," she said. We showed the brown fibres to the young couple who was equally as perplexed.
"Did your father use cotton buds to clean the right ear?" I asked.
"Yes," the lady said. Later she said that her father used cotton wool wrapped around a pair of forceps to clean this ear.
So, the clue was given. The father would have used lots of cotton wool over the past year to resolve the ear problem. The fibres loosened and got impacted inside the horizontal canal. The whole canal filled up. The fibres absorbed the "water" of the commercial ear drops. At the same time, the bleeding from the canal wall due to aggressive ear cleaning by the father stained the fibres into dark brown as red blood becomes brown over time. These were the fibres or "tumours" pulled out.
Is this hypothesis sound? It is an unusual case as there was no pus. No time for pus to form too as the father must be doing ear cleaning every day. Sometimes, the grown up children don't know what the father is doing in the care of the dog as they work long hours.
Dr Vanessa extracted as much as possible. Evidence shown. She showed the couple the ear canal via the auroscope.
Ear swab for bacterial culture. Blood test.
SOLUTION
My advice was to lateral canal resection to resolve the dog's problem once and for all. The impacted cotton wool is deep inside the horizontal canal and opening up the vertical canal to get the hidden wool is the best solution. Owners want one treatment not several visits. This is understandable for every one. I advise surgery one week later.
This dog had lots of "water" inside the ear canal. I palpated the right ear. There was some pain as the dog moved his head away. But not great pain. As I pressed the ear, more "watery" discharge come out. As I cleared the discharge with a piece of tissue and then pressed the ear, more "watery" discharge comes out. Not those thick yellow pus, but watery. Why?
It was as if the horizontal ear canal was a deep well with lots of water. "Did your father apply the commercial ear drops recently?" I asked.
"No," the young lady said. "No more ear drops left."
This was a most unusual case. It was as if there was "underground" water.
"This ear needed to be irrigated," I advised.
I collaborate with Dr Vanessa on this case as part of my mentorship and succession program for Toa Payoh Vets.
Each young vet has his or her own idea of treatment and I wanted to make sure that this dog had a treatment that I would be doing and to maintain a standard of care that would be satisfactory to dog owners who come to Toa Payoh Vets for second or more opinions.
TREATMENT
Domitor IV sedated the dog partly. Muzzled. Dr Vanessa put in the pink antiseptic solution into the ear canal, massaged it to clear the debri. That is the standard way and that would be what the other vets had been doing. Nothing wrong with that.
But it might not be effective compared to ear irrigation.
So I intervened and demonstrated how the ear irrigation ought to be done. There is a technique. I had shown this in my video at:
http://www.youtube.com/watch?v=xhZ5eGJdwnY
Dr Vanessa used the 20-ml syringe to flush the ear. "You need to exercise your thumb muscles," I said as she injected the water into the ear without much force. "The irrigation angle has to be at 45 degrees to the horizontal canal and with speed," I demonstrated. It is easier said and demonstrated than done.
White tissue pieces from the walls of the vertical canal came out. Large extensive ulcers. As I irrigated more, a small piece of brown tissue came out. Then a few more brown bits. Strange. No pus.
I left the room to talk to the couple. Then I returned to the room to continue working with Dr Vanessa. She had extracted a big amount of brownish fibres from deep inside the ear. Good work. "What are these brown stuff?" I asked her.
"It could be tumours," she said. We showed the brown fibres to the young couple who was equally as perplexed.
"Did your father use cotton buds to clean the right ear?" I asked.
"Yes," the lady said. Later she said that her father used cotton wool wrapped around a pair of forceps to clean this ear.
So, the clue was given. The father would have used lots of cotton wool over the past year to resolve the ear problem. The fibres loosened and got impacted inside the horizontal canal. The whole canal filled up. The fibres absorbed the "water" of the commercial ear drops. At the same time, the bleeding from the canal wall due to aggressive ear cleaning by the father stained the fibres into dark brown as red blood becomes brown over time. These were the fibres or "tumours" pulled out.
Is this hypothesis sound? It is an unusual case as there was no pus. No time for pus to form too as the father must be doing ear cleaning every day. Sometimes, the grown up children don't know what the father is doing in the care of the dog as they work long hours.
Dr Vanessa extracted as much as possible. Evidence shown. She showed the couple the ear canal via the auroscope.
Ear swab for bacterial culture. Blood test.
SOLUTION
My advice was to lateral canal resection to resolve the dog's problem once and for all. The impacted cotton wool is deep inside the horizontal canal and opening up the vertical canal to get the hidden wool is the best solution. Owners want one treatment not several visits. This is understandable for every one. I advise surgery one week later.
728. Scupturing dogs with veggie dyes and making them look like pandas etc - animal cruelty?
MY REPLY TO COMMENTS ON DOG DYED TO LOOK LIKE PANDAS AND OTHER ANIMALS
Thank you for your email. I have not seen one client Toa Payoh Vets with coloured/dyed dogs from 1982 to 2011. It is surprising.
If I do, I will advise the owner to check whether the dye is carcinogenic, allergic or toxic to the dog when licked and in the long term.
Nowadays, what is deemed animal cruelty in subjecting a dog to being dyed to one person is not cruel to another. As long as the quality of life of the pet is good and the pet is healthy despite "vegetable-dyed", I am not against this practice which you may consider cruel.
Older men and women dye their white or grey hairs to look younger. Young people dye their hair to look different. Such hair dyes may have long term toxic effects on the kidneys and livers as they are used for a long time to maintain youthfulness esp. in older people. This is my opinion that is not supported by scientific evidence, if any.
But most people don't bother about the safety aspects and that is why so many "herbal" and "nutritional/vitamin" pills with possible harmful effects to the liver and kidneys have great sales.
I hope my reply is satisfactory to you.
Thank you for your email. I have not seen one client Toa Payoh Vets with coloured/dyed dogs from 1982 to 2011. It is surprising.
If I do, I will advise the owner to check whether the dye is carcinogenic, allergic or toxic to the dog when licked and in the long term.
Nowadays, what is deemed animal cruelty in subjecting a dog to being dyed to one person is not cruel to another. As long as the quality of life of the pet is good and the pet is healthy despite "vegetable-dyed", I am not against this practice which you may consider cruel.
Older men and women dye their white or grey hairs to look younger. Young people dye their hair to look different. Such hair dyes may have long term toxic effects on the kidneys and livers as they are used for a long time to maintain youthfulness esp. in older people. This is my opinion that is not supported by scientific evidence, if any.
But most people don't bother about the safety aspects and that is why so many "herbal" and "nutritional/vitamin" pills with possible harmful effects to the liver and kidneys have great sales.
I hope my reply is satisfactory to you.
727. Dr Sing's presentation at the AVA Responsible Pet Ownership Seminar Sat Nov 12, 2011 1.30pm to 2 pm
30 minute talk. Instead of boring power point slides on how to be a responsible pet owner in Singapore, I will be showing videos
My videos on caring for your pet to permit it to live longer and have a good quality of life will likely be:
1. Oro-fistula and follow up in an old Chihuahua who had had pyometra
2. How to bathe a Roborovski hamster with generalised skin disease
3. Ear irrigations for a Golden Retriever with chronic ear infections
4. Emergency Caesarean section advices for the home-breeder
5. FIV in a stray cat
6. Blood in the urine in a dog
7. Tumours, Perineal hernias, Circum-anal tumours in older pets including hamsters, dogs, cats
8. Eye ulcers are emergencies.
9. Puppy parvoviral disease and prevention by vaccination.
Early detection of diseases and removal of tumour save lives. Be a responsible pet owner.
I hope the videos will last the 30-minute of talk and be entertaining and useful for the audience
My videos on caring for your pet to permit it to live longer and have a good quality of life will likely be:
1. Oro-fistula and follow up in an old Chihuahua who had had pyometra
2. How to bathe a Roborovski hamster with generalised skin disease
3. Ear irrigations for a Golden Retriever with chronic ear infections
4. Emergency Caesarean section advices for the home-breeder
5. FIV in a stray cat
6. Blood in the urine in a dog
7. Tumours, Perineal hernias, Circum-anal tumours in older pets including hamsters, dogs, cats
8. Eye ulcers are emergencies.
9. Puppy parvoviral disease and prevention by vaccination.
Early detection of diseases and removal of tumour save lives. Be a responsible pet owner.
I hope the videos will last the 30-minute of talk and be entertaining and useful for the audience
726. Regional nerve block in vet dentistry video
I spoke to Daniel, a Murdoch 5th year vet student who wrote a research article on the above subject and said it was inexpensive and fast and therefore should be used by vets.
I do not do regional nerve block in vet dentistry as the dog still needs General Anaesthesia, unlike human beings. Maybe in very old dogs? GA using isoflurane + oxygen is safe even for very old dogs. So I believe almost 99% of vets in private practice do not bother with regional nerve blocks in vet dentistry in the dog and cat.
However, I chanced upon a video on this subject today while doing my research for the AVA Responsible Pet Ownership 2011 Seminar on this Sat Nov 12,2011 at 1.3pm0 - 2 pm at Changi Expo. I will be showing videos rather than the boring Power Point Slides presentation. Probably only 10 adults and a few children will be present at this talk, from my past observations!
There is a video at:
http://www.youtube.com/watch?v=UtWUzkHnLTk&feature=related
I do not do regional nerve block in vet dentistry as the dog still needs General Anaesthesia, unlike human beings. Maybe in very old dogs? GA using isoflurane + oxygen is safe even for very old dogs. So I believe almost 99% of vets in private practice do not bother with regional nerve blocks in vet dentistry in the dog and cat.
However, I chanced upon a video on this subject today while doing my research for the AVA Responsible Pet Ownership 2011 Seminar on this Sat Nov 12,2011 at 1.3pm0 - 2 pm at Changi Expo. I will be showing videos rather than the boring Power Point Slides presentation. Probably only 10 adults and a few children will be present at this talk, from my past observations!
There is a video at:
http://www.youtube.com/watch?v=UtWUzkHnLTk&feature=related
Tuesday, November 8, 2011
725. AVA Responsible Pet Ownership Roadshow 2011
AVA Responsible Pet Ownership Roadshow 2011
12 & 13 November 2011
Singapore Expo Hall 4B
Toa Payoh Vets' Talk: Be A Responsible Home-breeder - Dystocia in the Dog
Story of 2 case studies - Small breeds with large pups
Experienced home-breeder. Arrangement with a vet to standby.
Inexperienced home-breeder. Veterinary Costs. Wait and See?
Delays in seeking Emergency Caesarean Section - What happens?
Hook 1 - After midnight emergency Caesarean Section
Video Scene of undertakers around Toa Payoh Vets. Ghosts roam after midnight? White apparitions seen outside clinic. Pass the case to other vets? Duty of care?
INTRODUCTION
MIDDLE - Case study 1. Experienced breeder saves surgery time.
Case study 2. Breeder does not know how to revive pup with water-logged lungs. I had to show. Swing hard but carefully. Picture.
CONCLUSION - Vet fees are higher after office hours. From $1,500 - $3,000.
Hook 2 - Public holiday
1. TRENDS IN SINGAPORE PET OWNERSHIP BY DR SING AS A VET FROM 1974 - 2011
1.1 MANY MORE CARING YOUNG ADULT SINGAPOREANS - BEST HEALTH CARE FOR THEIR PETS
1.2 CONFLICTS WITH SENIOR CITIZENS & DEPENDENTS - THE GOOGLE GENERATION V. SENIOR CITIZENS WHO ARE PRAGMATIC - BUYING A NEW PET IS CHEAPER THAN PAYING VET FEES. What values are imparted? Don't care when pets are old and sick? Get a new one!
2. ADVICES. DO NOT BREED. EMERGENCY CAESAREAN SECTIONS ARE RELATIVELY "EXPENSIVE" - FROM $1,500 - $3,000
3. IF YOU WANT TO BREED,
3.1 READ AND RESEARCH ON DOG PREGNANCY AND DYSTOCIAS IN YOUR BREED
3.2 BUILD A GOOD RELATIONSHIP OF TRUST WITH THEIR VET
3.3 BE ABLE TO AFFORD THE VET FEES FOR EMERGENCY CAESAREAN SECTIONS
3.4 FIND A VET WHO CHARGES $200 FOR A CAESAREAN SECTION?
3. MORE CAESAREAN SECTION CASE STUDIES BY DR SING AT:
http://www.bekindtopets.com/animals/20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm
CREDITS
PRODUCED AND NARRATED BY:
12 & 13 November 2011
Singapore Expo Hall 4B
Toa Payoh Vets' Talk: Be A Responsible Home-breeder - Dystocia in the Dog
Story of 2 case studies - Small breeds with large pups
Experienced home-breeder. Arrangement with a vet to standby.
Inexperienced home-breeder. Veterinary Costs. Wait and See?
Delays in seeking Emergency Caesarean Section - What happens?
Hook 1 - After midnight emergency Caesarean Section
Video Scene of undertakers around Toa Payoh Vets. Ghosts roam after midnight? White apparitions seen outside clinic. Pass the case to other vets? Duty of care?
INTRODUCTION
MIDDLE - Case study 1. Experienced breeder saves surgery time.
Case study 2. Breeder does not know how to revive pup with water-logged lungs. I had to show. Swing hard but carefully. Picture.
CONCLUSION - Vet fees are higher after office hours. From $1,500 - $3,000.
Hook 2 - Public holiday
1. TRENDS IN SINGAPORE PET OWNERSHIP BY DR SING AS A VET FROM 1974 - 2011
1.1 MANY MORE CARING YOUNG ADULT SINGAPOREANS - BEST HEALTH CARE FOR THEIR PETS
1.2 CONFLICTS WITH SENIOR CITIZENS & DEPENDENTS - THE GOOGLE GENERATION V. SENIOR CITIZENS WHO ARE PRAGMATIC - BUYING A NEW PET IS CHEAPER THAN PAYING VET FEES. What values are imparted? Don't care when pets are old and sick? Get a new one!
2. ADVICES. DO NOT BREED. EMERGENCY CAESAREAN SECTIONS ARE RELATIVELY "EXPENSIVE" - FROM $1,500 - $3,000
3. IF YOU WANT TO BREED,
3.1 READ AND RESEARCH ON DOG PREGNANCY AND DYSTOCIAS IN YOUR BREED
3.2 BUILD A GOOD RELATIONSHIP OF TRUST WITH THEIR VET
3.3 BE ABLE TO AFFORD THE VET FEES FOR EMERGENCY CAESAREAN SECTIONS
3.4 FIND A VET WHO CHARGES $200 FOR A CAESAREAN SECTION?
3. MORE CAESAREAN SECTION CASE STUDIES BY DR SING AT:
http://www.bekindtopets.com/animals/20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm
CREDITS
PRODUCED AND NARRATED BY:
Friday, November 4, 2011
724. Parasites/mites from dog to person
On Fri, Nov 4, 2011 at 12:43 AM, ...@gmail.com> wrote:
hi there, i've come across your website as i've been searching on google for an answer to my question:
my dog is currently being treated for parasites/mites, and now my daughter has strange bites and itches all over her arms and legs, could it be that the dog has passed her the parasites as well? what can i do for my daughter to help her as our family doctor's itching cream has not been working to relieve her itches at all.
thank you,
Name
E-MAIL REPLY FROM DR SING DATED NOV 4, 2011
You need to know what parasites/mites are involved in your dog by asking your vet to give you a vet report. Let the doctor know the diagnosis or seek a skin specialist/2nd opinion from another doctor.
hi there, i've come across your website as i've been searching on google for an answer to my question:
my dog is currently being treated for parasites/mites, and now my daughter has strange bites and itches all over her arms and legs, could it be that the dog has passed her the parasites as well? what can i do for my daughter to help her as our family doctor's itching cream has not been working to relieve her itches at all.
thank you,
Name
E-MAIL REPLY FROM DR SING DATED NOV 4, 2011
You need to know what parasites/mites are involved in your dog by asking your vet to give you a vet report. Let the doctor know the diagnosis or seek a skin specialist/2nd opinion from another doctor.
Thursday, November 3, 2011
723. House-call for Golden Retriever with ear area snipped
Nov 2, 2011.
"It sounds like a surgical case," I said to the lady who googled "house-call vets singapore" and phoned me as to whether I would do a house-call in East Singapore. She volunteered to bathe this dog. Her maid and the neighbour's were cleaning the neighbour's Golden Retriever. There was a big clump of matted hair behind the ear. So, the scissors cut off the matted lump. 50% of the skin depth was cut off too. Size of 4 cm x 5 cm. So, the kind lady phoned for a house call.
I got the transport man to bring the dog down to the Surgery at 12 noon.
A bit overweight.
SEDATION
28 kg. Unknown health status.
Domitor 0.4 + Ketamine 0.5 ml IV (1/3 calculated dose for 30kg, young healthy dog).
GR sedated within 1 minute but woke up
"It sounds like a surgical case," I said to the lady who googled "house-call vets singapore" and phoned me as to whether I would do a house-call in East Singapore. She volunteered to bathe this dog. Her maid and the neighbour's were cleaning the neighbour's Golden Retriever. There was a big clump of matted hair behind the ear. So, the scissors cut off the matted lump. 50% of the skin depth was cut off too. Size of 4 cm x 5 cm. So, the kind lady phoned for a house call.
I got the transport man to bring the dog down to the Surgery at 12 noon.
A bit overweight.
SEDATION
28 kg. Unknown health status.
Domitor 0.4 + Ketamine 0.5 ml IV (1/3 calculated dose for 30kg, young healthy dog).
GR sedated within 1 minute but woke up
722. Cracked RU PM4 in golden retriever
A young couple saw me today for a second opinion as the dog was chewing on the left side for the past 2 weeks. He was fed lamb shanks and raw diet for some years but recently cracked his RU Premolar.
A red hole 1 mm in diameter was obvious and so I thought it was the cause of the tooth ache. The owner had palpated the tooth and there was a sliding of the upper front part of the tooth and told me. Indeed, there was movement. I shone a torch.
Still it took nearly 30 minutes of review and palpation before I finally concluded that the dog actually had a V-shaped fracture sideways from the upper anterior end! At one review, red blood oozed out from the crack. A v-shaped side fracture!
That was why it was moving. The owner gave treats many times to prevent the dog biting the vet and so there was some distractions. But at least, it was not the gum.
A red hole 1 mm in diameter was obvious and so I thought it was the cause of the tooth ache. The owner had palpated the tooth and there was a sliding of the upper front part of the tooth and told me. Indeed, there was movement. I shone a torch.
Still it took nearly 30 minutes of review and palpation before I finally concluded that the dog actually had a V-shaped fracture sideways from the upper anterior end! At one review, red blood oozed out from the crack. A v-shaped side fracture!
That was why it was moving. The owner gave treats many times to prevent the dog biting the vet and so there was some distractions. But at least, it was not the gum.
721. Expert questions autopsy findings: liposuction death
Dr Stephen Leadbeatter, foerensic pathologist, Cardiff University, Wales Institute of Forensic Medicine told a coroner's enquiry into the liposuction death. He said that based on the available info, he could not ascertain which aspect of the operation caused the death of Mr Franklin Heng. He was the expert witness for Dr Jim Wong, a GP who carried out the procedure.
Health Sciences Authority (HSA) said the death was caused by mulltiple punctures in the intestines due to the liposuction. HSA consultant forensic pathologist said the holow steel tube used could have caused the patient to go into shock and died.
Dr leadbeatter's points for the defence are:
1. He saw images from the autopsy, but said it was unclear whether the puncture wounds had gone fully into the intestines.
2. He saw no signs of peritonitis, the thin lining of the peritoneal cavity. If there was full puncture, the intestinal contents would have spilled out of the intestines into the peritoneum.
3. Lack of info about the description of any intestinal contents in the peritoneal cavity
4. Lack of microscopy to determine peritonitis
5. Another possible cause of death could be fat emboism - fat entering the blood stream into the lungs and brain. He had seen only slides of the b rain, not other organs.
6. Mr Heng could have difficulty breathing from an allergic reaction. This issue was not addressed in the blood taken.
7. Propofol used as a sedative could have contributed to the death according to the autopsy report.
But Dr Leadbeatter said the concentration of drug in the blood after death might not correctly be the same amount at the time of death.
In my reading of the report, there was no info as to whether peritonitis was present or not present and it seemed that the intestinal punctures did not go into the full thickness of the intestines. Will follow up.
Health Sciences Authority (HSA) said the death was caused by mulltiple punctures in the intestines due to the liposuction. HSA consultant forensic pathologist said the holow steel tube used could have caused the patient to go into shock and died.
Dr leadbeatter's points for the defence are:
1. He saw images from the autopsy, but said it was unclear whether the puncture wounds had gone fully into the intestines.
2. He saw no signs of peritonitis, the thin lining of the peritoneal cavity. If there was full puncture, the intestinal contents would have spilled out of the intestines into the peritoneum.
3. Lack of info about the description of any intestinal contents in the peritoneal cavity
4. Lack of microscopy to determine peritonitis
5. Another possible cause of death could be fat emboism - fat entering the blood stream into the lungs and brain. He had seen only slides of the b rain, not other organs.
6. Mr Heng could have difficulty breathing from an allergic reaction. This issue was not addressed in the blood taken.
7. Propofol used as a sedative could have contributed to the death according to the autopsy report.
But Dr Leadbeatter said the concentration of drug in the blood after death might not correctly be the same amount at the time of death.
In my reading of the report, there was no info as to whether peritonitis was present or not present and it seemed that the intestinal punctures did not go into the full thickness of the intestines. Will follow up.
720. Tray-training a Golden Retriever puppy
On Tue, Nov 1, 2011 at 11:14 PM, ...@hotmail.com> wrote:
Hello there, came across a site where you've provided information of toilet training dogs. I current have some enquiries and I would be glad if you could help me with it. I've gotten a golden retriever pup 4 days ago and he is 2 month old. We've been crating him with a tray inside and some space left for him to lie down. So far while in the crate, when he needs to do his business he would do it on the tray and not on the empty space. However during the day, we will let him out to play and only let him in during his nap time. This has caused several accidents. However, after observing, we noticed some consistency in his pee and poo time so we bring him out when we feel he needs to release and hence the no of accident has decreased. We have another tray placed outside where I hope I can train him to do his business there. However every time we place him on the tray, he will start sniffing and will without fail walk out of the tray and do his business outside the tray. I have placed tissue soaked in his urine and poo with new newspaper on top of it and metal grill to prevent him from stepping on his pee or chewing the paper. I was wondering what should be done to train him to use the tray instead of the floor. Should I lease him so he cannot wonder off the tray or should I 'fence up' his toilet area and only let him out after he do his business. My friend recommended me to leave him in his crate for a month and not let him out at all even to play so he will get toilet trained . But I don't think it's a good idea to crate him up without letting him out as I'm afraid of complications such as too much energy not release and becoming destructive or excited once let out etc. I hope you can give me some advice on what to do. Your help will be greatly appreciated.
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I am Dr Sing from Toa Payoh Vets. I assume you want the puppy to pee and poop on a "tray". Is the tray of sufficient size as this is a big breed? What are the dimensions?
Pl send at least 3 images of housing and layout plan as what I visualise about the tools you are using for toilet-training, based on your text description, may be incorrect. A "tray" to you can be a floor grate + pee tray below to another dog owner.
Hello there, came across a site where you've provided information of toilet training dogs. I current have some enquiries and I would be glad if you could help me with it. I've gotten a golden retriever pup 4 days ago and he is 2 month old. We've been crating him with a tray inside and some space left for him to lie down. So far while in the crate, when he needs to do his business he would do it on the tray and not on the empty space. However during the day, we will let him out to play and only let him in during his nap time. This has caused several accidents. However, after observing, we noticed some consistency in his pee and poo time so we bring him out when we feel he needs to release and hence the no of accident has decreased. We have another tray placed outside where I hope I can train him to do his business there. However every time we place him on the tray, he will start sniffing and will without fail walk out of the tray and do his business outside the tray. I have placed tissue soaked in his urine and poo with new newspaper on top of it and metal grill to prevent him from stepping on his pee or chewing the paper. I was wondering what should be done to train him to use the tray instead of the floor. Should I lease him so he cannot wonder off the tray or should I 'fence up' his toilet area and only let him out after he do his business. My friend recommended me to leave him in his crate for a month and not let him out at all even to play so he will get toilet trained . But I don't think it's a good idea to crate him up without letting him out as I'm afraid of complications such as too much energy not release and becoming destructive or excited once let out etc. I hope you can give me some advice on what to do. Your help will be greatly appreciated.
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I am Dr Sing from Toa Payoh Vets. I assume you want the puppy to pee and poop on a "tray". Is the tray of sufficient size as this is a big breed? What are the dimensions?
Pl send at least 3 images of housing and layout plan as what I visualise about the tools you are using for toilet-training, based on your text description, may be incorrect. A "tray" to you can be a floor grate + pee tray below to another dog owner.
719. Update on animal activist's help of a tick fever rescue dog
Update on animal activist's help of a tick fever rescue dog
The Rescue Group's vet had said that imizole would not be effective against Babesia gibsoni and advised a triple-drug combination costing $1,000. The rescue group wanted this activist to pay $600 to top up the $600 budget from the rescue group. The activist sought my advice by text and there was some delays as the Rescue Group's vet said that Berenil would be available as a cheap alternative in a few days' time. So the activist waited. But no Berenil. The activist was pro-active and posted online for help. A donor responded and would pay for treatment by the donor's vet. It seems that this rescue dog will survive the tick fever and that is good news for her and for anyone.
The following is her reply to my follow-up on her rescue dog's status
E-MAIL TO DR SING DATED NOV 2, 2011
...@hotmail.com>
Hi,
Its been a busy few days.
The Berenil is discontinued in Singapore already, and the rescue people told me I have to pay myself or let her die. We brought her home on Saturday and on Sunday she was having difficulty breathing and could not stand up. I posted her pictures online and a very kind stranger offered to pay for her treatment on the condition that we go to her vet. ... is being treated at (Name of vet practice given) as requested by the donor.
Her red count had dropped even further, and her platelets dropped to only 12. She stayed there for 2 nights and they gave her lots of supportive fluid therapy, erythropoietin and used steroids to stop the hemolysis. She perked up very well and is now resting at home. We will repeat her blood count on Friday and give her Imizole on Saturday if all goes well. For now she is on pred, metronidazole, doxycyclin and some other supplements. I was also forcefeeding her Hill's a/d several times a day. As of this morning she was willingly eating herself! I think things are looking up and Dr ... thinks she will survive. I hope the Imizole works to cure the infection.
I'm sorry we were not able to take her to you. I have great faith in your clinic, but unfortunately the money is not mine! :(
Thank you so much for your concern, you are very kind..
Btw, she's not my dog! We are just fostering her and hopefully will find her a home.
Smile,
Name
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I thank you for being proactive in helping the stray dog. The vet is doing a great job and I am quite sure imizole will be effective. Best wishes.
The Rescue Group's vet had said that imizole would not be effective against Babesia gibsoni and advised a triple-drug combination costing $1,000. The rescue group wanted this activist to pay $600 to top up the $600 budget from the rescue group. The activist sought my advice by text and there was some delays as the Rescue Group's vet said that Berenil would be available as a cheap alternative in a few days' time. So the activist waited. But no Berenil. The activist was pro-active and posted online for help. A donor responded and would pay for treatment by the donor's vet. It seems that this rescue dog will survive the tick fever and that is good news for her and for anyone.
The following is her reply to my follow-up on her rescue dog's status
E-MAIL TO DR SING DATED NOV 2, 2011
...@hotmail.com>
Hi,
Its been a busy few days.
The Berenil is discontinued in Singapore already, and the rescue people told me I have to pay myself or let her die. We brought her home on Saturday and on Sunday she was having difficulty breathing and could not stand up. I posted her pictures online and a very kind stranger offered to pay for her treatment on the condition that we go to her vet. ... is being treated at (Name of vet practice given) as requested by the donor.
Her red count had dropped even further, and her platelets dropped to only 12. She stayed there for 2 nights and they gave her lots of supportive fluid therapy, erythropoietin and used steroids to stop the hemolysis. She perked up very well and is now resting at home. We will repeat her blood count on Friday and give her Imizole on Saturday if all goes well. For now she is on pred, metronidazole, doxycyclin and some other supplements. I was also forcefeeding her Hill's a/d several times a day. As of this morning she was willingly eating herself! I think things are looking up and Dr ... thinks she will survive. I hope the Imizole works to cure the infection.
I'm sorry we were not able to take her to you. I have great faith in your clinic, but unfortunately the money is not mine! :(
Thank you so much for your concern, you are very kind..
Btw, she's not my dog! We are just fostering her and hopefully will find her a home.
Smile,
Name
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I thank you for being proactive in helping the stray dog. The vet is doing a great job and I am quite sure imizole will be effective. Best wishes.
718. Follow up on Cocker Spaniel with tick fever - 14 days later
SUNDAY'S INTERESTING CASES
Oct 30, 2011
On Friday, Oct 28, 2011, I got a text message from a young lady caring for a Singapore Rescue Group's stray dog with tick fever diagnosed by Vet 1 consulted by the Group. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever would be ineffective as this dog had Babesia gibsoni.
As imizole is "ineffective" against Babesia gibsoni, Vet 1 wanted to use the "3 effective" drugs atovaquone, clindamycine and azithromycin. However, it would cost the Rescue Group $1,000. Berenil was cheaper but might cause anaphylaxic shock and in any case there was no stock at that time.
The Rescue Group asked her to top up the bill but she did not have the means to do so. So, she texted me for advice and alternative options.
Below are my replies to her.
It is kind of you to do dog rescue work. There are many financial considerations.
Combination of atovaquone, clindamycine and azithromycin by (required by Vet 1) as said by you, is claimed by Vet 1 to be effective against Babesia gibsoni infections in this dog. Vet 1 had said that imizole is ineffective against Babesia gibsoni.
I will not comment further as I don't use these expensive drugs. Success rate depends on follow up, not just one injection. Blood transfusion 1.5 bags at $500/bag and hospitalisation will be more than $600 budget from the Rescue group.
Berenil is cheap but anaphylaxis according to your text. Hb at 5 is low for your affected dog, but you also need to know total RBC.
In conclusion, anti-tick fever treatment is not cheap due to prolonged treatment and follow ups.
E-MAIL TO DR SING DATED Oct 29 (2 days ago)
Thank you very much Dr Sing. I am heading out to check on the dog this morning. If the rescue doesn't want to pay for treatment, I think I will bring the dog home to die as she doesn't like the cage...
Thanks again. Will email u soon.
Name given
COMMENTS
The dog was sent home without the expensive treatment or imizole. The lady activist thought that the dog was "alone" at the vet clinic and she would take the dog home to die. Berenil would be available possibly 2 days later.
Coincidentally, I was following up on an English cocker spaniel, 11.5 kg with Babesia gibsoni and Ehrlichia tick fever 10 days ago. A Cocker Spaniel has tick fever in 2011 is the case report.
Day 1 to Day 5 of tick fever
She came today (Sunday Oct 30, 2011) for her 2nd imizole injection (0.6 ml SC today) 10 days after the first injection (0.5 ml SC). Based on her active normal behaviour and much pinker gums, the first imizole injection had worked. Otherwise she should be dead by now.
So, should Vet 1 have given imizole to that stray dog rather than wait for the cheaper Berenil to be available later? Is imizole totally ineffective against Babesia gibsoni? I related the story of the stray dog with tick fever to the cocker spaniel and she was worried that I had not given the correct treatment.
Day 1 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 10 --->
"Will you dog be active and rushing out to play and have pink gums 10 days after the first injection if imizole was ineffective?" I asked her as I gave the 2nd injection today. As the dog still had ticks attached to her head and spinal area, I asked: "Does your dog go under the bed?". She said "Yes, my dog likes to sleep under the bed." I said: "Ticks may be present on the under part of the bed and attaches to the dog. Advantix should work as this spot-on was given 10 days ago when the dog came in. Give another dose in 4 days." I wanted to prescribe the anti-tick wash but did not as I asked her to use the Advantix and the dog had not many ticks.
My thoughts on this fine Sunday morning were for that stray dog and the caregiver who was a student. The young Singaporeans prefer to text and on Saturday, Oct 29, 2011, 2.53 pm, I got the following:
"Dr Sing, I brought the dog home as they could not do anything for her. Rescue opted to try Berenil but can't get for a few days so we are waiting. She is very weak. I think she may be dying. How much is one shot of imizole? Do u think it is worth a try? If not too expensive, I don't mind trying myself. What else can we do for her in the meantime?
I phoned her on Saturday and told her to bring the dog for the imizole injection on Saturday at 9.30 am. But she said that the transport was not available. In any case, the Berenil may be available on Monday and the dog was still alive. So I hope that this dog had the Berenil treatment soon.
As for the English Cocker Spaniel, as at Nov 3, 2011, the dog is normal. "Except that she tires easily," the owner said to me. She submitted a urine sample for testing. The values were normal. The urine SG was high, at 1.041 (range should be 1.005 -1.030), pH was 7.0 and struvite crystals were present. "Could it be the high liver I am feeding?" the lady asked me. "Should I stop feeding the liver?" She was also feeding iron supplements and all the good home-cooked food. "Since your dog tires easily, she has not fully recovered her normal red cell amount," I said. "The high urine SG is unusual. It shows that the kidneys can concentrate the urine well but what causes it is hard to say." I may need to have another urine test 2 weeks later.
Nov 3, 2011, as I update this report, I had been thinking about the high urine SG. My hypothesis is that the destruction of so many red and white blood cells damaged by the Babesia and Ehrlichia organisms during the past 14 days would have contributed to a large amount of protein damage for the past few days. The kidneys are normal and have to work hard to excrete the urea. This resulted in a high urine SG. There may be a high blood urea but I did not take a blood sample when the urine sample was sent.
Since the kidneys and bladder were normal, there was no proteinuria during urinalysis. Is this hypothesis sound? These are the types of questions the professor may ask in a case study during the final exam of the 5th year vet student. I remembered my "viva" or "oral exam" on a case study during my final year by my Professor of Vet Medicine and an external examiner and I presume Murdoch vet students still get this oral test.
A reply or hypothesis may not be possible for a vet student so much burdened with 5 years of vet knowledge memorised to pass the Final examination in November 2011 if the Professor of Vet Medicine asked about the high SG during the oral test!
Earlier report: A Cocker Spaniel has tick fever in 2011 or
http://www.sinpets.com/dogs/20111039tick-fever-cocker-spaniel-singapore-toapayohvets.htm
IT IS NOT POSSIBLE FOR ME TO POST THE VARIOUS EDUCATIONAL IMAGES ON BLOGGER.COM
UPDATES AND MORE IMAGES WILL BE AT TOA PAYOH VETS
http://www.sinpets.com/dogs/20111036babesia-gibsoni-treatment-drug-imizole-success-singapore-toapayohvets.htm
Oct 30, 2011
On Friday, Oct 28, 2011, I got a text message from a young lady caring for a Singapore Rescue Group's stray dog with tick fever diagnosed by Vet 1 consulted by the Group. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever would be ineffective as this dog had Babesia gibsoni.
As imizole is "ineffective" against Babesia gibsoni, Vet 1 wanted to use the "3 effective" drugs atovaquone, clindamycine and azithromycin. However, it would cost the Rescue Group $1,000. Berenil was cheaper but might cause anaphylaxic shock and in any case there was no stock at that time.
The Rescue Group asked her to top up the bill but she did not have the means to do so. So, she texted me for advice and alternative options.
Below are my replies to her.
It is kind of you to do dog rescue work. There are many financial considerations.
Combination of atovaquone, clindamycine and azithromycin by (required by Vet 1) as said by you, is claimed by Vet 1 to be effective against Babesia gibsoni infections in this dog. Vet 1 had said that imizole is ineffective against Babesia gibsoni.
I will not comment further as I don't use these expensive drugs. Success rate depends on follow up, not just one injection. Blood transfusion 1.5 bags at $500/bag and hospitalisation will be more than $600 budget from the Rescue group.
Berenil is cheap but anaphylaxis according to your text. Hb at 5 is low for your affected dog, but you also need to know total RBC.
In conclusion, anti-tick fever treatment is not cheap due to prolonged treatment and follow ups.
E-MAIL TO DR SING DATED Oct 29 (2 days ago)
Thank you very much Dr Sing. I am heading out to check on the dog this morning. If the rescue doesn't want to pay for treatment, I think I will bring the dog home to die as she doesn't like the cage...
Thanks again. Will email u soon.
Name given
COMMENTS
The dog was sent home without the expensive treatment or imizole. The lady activist thought that the dog was "alone" at the vet clinic and she would take the dog home to die. Berenil would be available possibly 2 days later.
Coincidentally, I was following up on an English cocker spaniel, 11.5 kg with Babesia gibsoni and Ehrlichia tick fever 10 days ago. A Cocker Spaniel has tick fever in 2011 is the case report.
Day 1 to Day 5 of tick fever
She came today (Sunday Oct 30, 2011) for her 2nd imizole injection (0.6 ml SC today) 10 days after the first injection (0.5 ml SC). Based on her active normal behaviour and much pinker gums, the first imizole injection had worked. Otherwise she should be dead by now.
So, should Vet 1 have given imizole to that stray dog rather than wait for the cheaper Berenil to be available later? Is imizole totally ineffective against Babesia gibsoni? I related the story of the stray dog with tick fever to the cocker spaniel and she was worried that I had not given the correct treatment.
Day 1 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 10 --->
"Will you dog be active and rushing out to play and have pink gums 10 days after the first injection if imizole was ineffective?" I asked her as I gave the 2nd injection today. As the dog still had ticks attached to her head and spinal area, I asked: "Does your dog go under the bed?". She said "Yes, my dog likes to sleep under the bed." I said: "Ticks may be present on the under part of the bed and attaches to the dog. Advantix should work as this spot-on was given 10 days ago when the dog came in. Give another dose in 4 days." I wanted to prescribe the anti-tick wash but did not as I asked her to use the Advantix and the dog had not many ticks.
My thoughts on this fine Sunday morning were for that stray dog and the caregiver who was a student. The young Singaporeans prefer to text and on Saturday, Oct 29, 2011, 2.53 pm, I got the following:
"Dr Sing, I brought the dog home as they could not do anything for her. Rescue opted to try Berenil but can't get for a few days so we are waiting. She is very weak. I think she may be dying. How much is one shot of imizole? Do u think it is worth a try? If not too expensive, I don't mind trying myself. What else can we do for her in the meantime?
I phoned her on Saturday and told her to bring the dog for the imizole injection on Saturday at 9.30 am. But she said that the transport was not available. In any case, the Berenil may be available on Monday and the dog was still alive. So I hope that this dog had the Berenil treatment soon.
As for the English Cocker Spaniel, as at Nov 3, 2011, the dog is normal. "Except that she tires easily," the owner said to me. She submitted a urine sample for testing. The values were normal. The urine SG was high, at 1.041 (range should be 1.005 -1.030), pH was 7.0 and struvite crystals were present. "Could it be the high liver I am feeding?" the lady asked me. "Should I stop feeding the liver?" She was also feeding iron supplements and all the good home-cooked food. "Since your dog tires easily, she has not fully recovered her normal red cell amount," I said. "The high urine SG is unusual. It shows that the kidneys can concentrate the urine well but what causes it is hard to say." I may need to have another urine test 2 weeks later.
Nov 3, 2011, as I update this report, I had been thinking about the high urine SG. My hypothesis is that the destruction of so many red and white blood cells damaged by the Babesia and Ehrlichia organisms during the past 14 days would have contributed to a large amount of protein damage for the past few days. The kidneys are normal and have to work hard to excrete the urea. This resulted in a high urine SG. There may be a high blood urea but I did not take a blood sample when the urine sample was sent.
Since the kidneys and bladder were normal, there was no proteinuria during urinalysis. Is this hypothesis sound? These are the types of questions the professor may ask in a case study during the final exam of the 5th year vet student. I remembered my "viva" or "oral exam" on a case study during my final year by my Professor of Vet Medicine and an external examiner and I presume Murdoch vet students still get this oral test.
A reply or hypothesis may not be possible for a vet student so much burdened with 5 years of vet knowledge memorised to pass the Final examination in November 2011 if the Professor of Vet Medicine asked about the high SG during the oral test!
Earlier report: A Cocker Spaniel has tick fever in 2011 or
http://www.sinpets.com/dogs/20111039tick-fever-cocker-spaniel-singapore-toapayohvets.htm
IT IS NOT POSSIBLE FOR ME TO POST THE VARIOUS EDUCATIONAL IMAGES ON BLOGGER.COM
UPDATES AND MORE IMAGES WILL BE AT TOA PAYOH VETS
http://www.sinpets.com/dogs/20111036babesia-gibsoni-treatment-drug-imizole-success-singapore-toapayohvets.htm
Tuesday, November 1, 2011
717. Recurrent UTI in an old Corgi is hard to treat
Recurrent UTI in an old Corgi is hard to treat
Every dog owner and probably person will be warned about anaesthetic risks. For owners who don't want the risk, there are groomers in Singapore who find this opportunity to provide a service involving dental scaling of dogs without any anaesthesia.
Vets do not use anaesthetic on dogs unnecessary to avoid any anaesthetic risks as the high emotions of grieving of dogs dead during anaesthesia are terrible for the vet and the staff.
Since most dogs will not tolerate manual dental scaling, the groomer's assistant must grip the dog's legs tight to enforce cooperation. It is like the old days when people are held tightly by men during surgeries or given a dose of whisky. In dogs, the groomer can't sedate as the service is supposed to be no anaesthetic or sedation.
Recently I had a case of a poodle that had stopped eating for over 3 days and could not stand up. The two teenaged daughters were worried that their dog may die. The mother had taken the dog to a groomer in Sembawang pet shop to get dental scaling done. I remembered this case as the mother was running a mini-mart and I had vaccinated her dog some 3 years ago. It was a puppy then. I had the dog's blood checked, gave the IV drip and antibiotics. There was hypoglycaemia. The dog's mouth probably was very painful after enforced dental scaling by the groomer and so he would not eat. He recovered within 2 days of treatment and went home to two happy teenaged daughters and a relieved mother.
Yesterday, Oct 31, 2011, I had this 9-year-old Corgi whose lady owner was vacillating as to whether to get her dental scaling done or not. Her dog would lick at the vagina after the course of antibiotics lasting as long as one month and the urine would have blood clots or blood when all the antibiotics have been taken.
She had consulted several vets in one brand name practice for more than 10 times over the last two years after being referred to this practice by another vet who could not cure her dog's blood in the urine problem. This was because the brand name practice has all the facilities, according to the vet referring her to this practice. Ultrasound of the kidney and bladders, urine tests, urine culture and sensitivity and blood tests were done at various times over the two years. There was said to be an X-ray done but the practice said there was no record available.
But her dog would pass smelly urine with blood after a course of antibiotics prescribed by these vets. She was not happy with this situation. One vet had advised surgery of the bladder to remove "polyps" but had told her about anaesthetic risk and that the surgery was not meant to be a cure for the recurring problem of passing blood in the urine.
She phoned me to seek another opinion recently. I have the benefit of these tests. Three urine tests at different times showed struvites in the urine. The facilities or tools of the trade were used by the vets but the owner's problems were not resolved.
It was like my car's problem. My car would display "Check coolant level" and I would send the car to my usual mechanic for 4 times. The mechanics were two older men in their late 60s distinguished with snow-white hairs and specialising in the brand of car I drove. I presumed they must have the experience as their hairs were all white. I never bargained or squeezed them for discount after they service my car, as is the case with many pet owners at Toa Payoh Vets.
At the 4th time "Check coolant level," message flashed, I asked the mechanic whether he could do the job. I had to replace 2000 ml of water in 5 days after he had assured me that he had resolved my problem.
I cannot afford putting my car overnight and then encounter the same problem again. The old man pointed to some water spots on the radiator and said he knew what to do. He diagnosed the radiator cap as being damaged and therefore leaked the coolant. He said he had used pressure tests and there was no other leakage. Earlier he had put some liquid which could seal any cracks but they did not work.
Yet, I got the same problem. On the 5th time, he said he would check again. He said the 5-month-old German-made radiator was faulty and had replaced with a French-made radiator. The supplier of the German-made radiator would not provide a replacement and therefore I had to pay him $500. "The 'check coolant level' was reported within 2 months of getting the German-made radiator," I said. "I wish to speak to the distributor as he is selling faulty goods and cheating people." The old man said it was of no use. "I was referred to another mechanic down the road," I said to the old man. "You could not resolve my problem for so many times."
With the new radiator replaced, I checked the water level 5 days later. There was a need to top up 200 ml of water. So, was there a leakage or not? I have to wait and see.
My situation is similar with that of the Corgi owner as I entrusted my mechanic to resolve my problem. He recommended replacement of the radiator and some pumps and the bill came up to $7,000!
Only that she had consulted the same practice for over 10 times without resolution of her problems and I would not be surprised if she had spent $7,000 too. I did not ask her. But I could empathise with her.
DENTAL SCALING DONE TODAY
I use the same guideline for sedation
A 10-kg healthy young dog - 0.4 ml domitor + 0.5 ml ketamine IV
The Corgi weighed around 14 kg but she was old. Blood tests were normal but no chest x-ray of the heart was done today as this is the usual practice. In human anaesthesia, a chest x-ray at Singapore General Hospital where I went for surgery, was mandatory.
In this Corgi, I gave 0.1 ml domitor + 0.1 ml ketamine mixed with 0. 3 ml normal saline and gave IV. This was less than 20% of the formula but the dog was sedated 80%. I used isoflurane gas to top up.
"No need," my assistant Min said when I told him to apply a tourniquet.
"Sometimes it is not needed," I said. "But I see that you have wasted a lot of time in some cases where no tourniquet was used as the blood collection or injection was not possible at the first attempt."
The dog had a tourniquet and the cephalic vein was distended. The sedatives were given.
I monitored the isoflurane gas + oxygen very carefully as the lady owner entrusted me and expected the dog to be OK. Eyelid blinking to be zero and maintenance of isoflurane was 0.5 - 1%. The dog had bilateral cataracts but I could monitor the closing of the pupil. It still took 45 minutes to complete the whole dental scaling. Solid teeth. Tartar only esp. on PM4 upper, both sides.
The owner had said, "My dog had only one anaesthesia and that was when she was spayed." I said: "That was some 6 years ago and she was healthy then. I advise an X-ray of the chest."
ULTRASOUND OF THE BLADDER AND X-RAY OF THE CHEST AND ABDOMEN AT 11.30 AM
I collaborate with an experienced vet who did the ultrasound and X-rays. I brought the Corgi personally to discuss with him the use of the tools of the trade - the ultrasound and the X-rays and how he would interpret the results. I had wanted a contrast cystography involving injecting dyes into the dog and X-raying the kidneys and bladder to check for tumours and stones. However the cost of $500 inclusive of anaesthesia was above budget. I had to find other lower cost alternatives and in any case, there was anaesthesia which I had just performed during dental scaling in the morning.
To cut a long story short, the ultrasound showed lots of floating sandy particles inside the bladder as reported by previous vets doing the ultrasound. There was thickened bladder wall but no polyps or transitional cell carcinoma inside the bladder. "Otherwise the Doppler would show blood flowing into the mass on the inside of the bladder," the vet I collaborated with said to me. "There was zero blood flow and therefore the sandy particles were separate from any mucosa." Excellent use of the tools of the trade, I must commend him.
On X-rays, I could see radio-dense bladder indicative of struvites (as reported by urine tests by the previous vets). The owner collected urine in the morning but I had treated the dog with antibiotics 2 days ago. I wanted the X-ray to see if there were large struvite stones. There were none.
Lots of radio-dense sandy particles float inside the bladder. Could they be struvite sand or inflammatory cells?
Yet the urine test taken on the same day is negative for epithelial, white blood and red blood cells and crystals, mucus threads, yeast and bacteria.
The urine test I sent to the lab today show normal urine. Amber, clear, no nitrite, protein, glucose, ketones, urobilinogen (normal), bilirubin, blood. Urine microscopy - no white or ed blood cells, no epithelial cells, casts, crystals, bacteria, mucus threads. yeast or others.
The pH was 7.0 (5-8) and SG was 1.018 (1.0905-1.030).
Based on history, the sandy particles would be struvites or inflammatory cells.
I had to treat the dog 2 days ago as it was quite distressing for the owner. In any case, urine bacterial culture and sensitivity tests had been done by the other vets and Proteus mirabilis was found in one time. So, I did not repeat again to save the owner some money. Baytril had worked and the dog was no more passing blood in the urine while on antibiotics.
What is the next step now that the bladder is shown to be free from tumours and polyps which would cause recurrent UTI? I recommend dental scaling which was done. The next step would be SD diet for 3-4 months to acidify the urine. If this works, it will be happy days for the owner. I will use urine acidifiers and review the case in 4 weeks. Will I succeed where others fail? Only time will tell whether I can resolve the lady's pet problem of recurring UTI. This dog was well beloved as not many Singapore owners would bother to take the dog for over 10 times to treat for blood in the urine. One or two times and that's it for the old girl!
CONCLUSION
The history of the case reports from the other vets is much more important than one urine test. I would say that struvite and inflammatory cells are present.
The dog has chronic cystitis and recurrent UTI. Tumours have been ruled out as a cause. Blood test before antibiotic treatment was normal and so a other-source of infection via the blood is ruled out. This leaves struvites are a cause. The pH 7.0 is not acidic. Nor alkaline but this should be reduced to produce acidic urine to stop bacterial growth.
P.S. The dog's heart was enlarged but when I auscultated the heart, the heart sounds were normal. "Why is the heart enlarged?" the owner asked. "It may be due to old age or congenital or other reasons," I said. The dog did feel short of breath at certain times. Will update this webpage.
Updates will be at: Toa Payoh Vets webpage:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm
Every dog owner and probably person will be warned about anaesthetic risks. For owners who don't want the risk, there are groomers in Singapore who find this opportunity to provide a service involving dental scaling of dogs without any anaesthesia.
Vets do not use anaesthetic on dogs unnecessary to avoid any anaesthetic risks as the high emotions of grieving of dogs dead during anaesthesia are terrible for the vet and the staff.
Since most dogs will not tolerate manual dental scaling, the groomer's assistant must grip the dog's legs tight to enforce cooperation. It is like the old days when people are held tightly by men during surgeries or given a dose of whisky. In dogs, the groomer can't sedate as the service is supposed to be no anaesthetic or sedation.
Recently I had a case of a poodle that had stopped eating for over 3 days and could not stand up. The two teenaged daughters were worried that their dog may die. The mother had taken the dog to a groomer in Sembawang pet shop to get dental scaling done. I remembered this case as the mother was running a mini-mart and I had vaccinated her dog some 3 years ago. It was a puppy then. I had the dog's blood checked, gave the IV drip and antibiotics. There was hypoglycaemia. The dog's mouth probably was very painful after enforced dental scaling by the groomer and so he would not eat. He recovered within 2 days of treatment and went home to two happy teenaged daughters and a relieved mother.
Yesterday, Oct 31, 2011, I had this 9-year-old Corgi whose lady owner was vacillating as to whether to get her dental scaling done or not. Her dog would lick at the vagina after the course of antibiotics lasting as long as one month and the urine would have blood clots or blood when all the antibiotics have been taken.
She had consulted several vets in one brand name practice for more than 10 times over the last two years after being referred to this practice by another vet who could not cure her dog's blood in the urine problem. This was because the brand name practice has all the facilities, according to the vet referring her to this practice. Ultrasound of the kidney and bladders, urine tests, urine culture and sensitivity and blood tests were done at various times over the two years. There was said to be an X-ray done but the practice said there was no record available.
But her dog would pass smelly urine with blood after a course of antibiotics prescribed by these vets. She was not happy with this situation. One vet had advised surgery of the bladder to remove "polyps" but had told her about anaesthetic risk and that the surgery was not meant to be a cure for the recurring problem of passing blood in the urine.
She phoned me to seek another opinion recently. I have the benefit of these tests. Three urine tests at different times showed struvites in the urine. The facilities or tools of the trade were used by the vets but the owner's problems were not resolved.
It was like my car's problem. My car would display "Check coolant level" and I would send the car to my usual mechanic for 4 times. The mechanics were two older men in their late 60s distinguished with snow-white hairs and specialising in the brand of car I drove. I presumed they must have the experience as their hairs were all white. I never bargained or squeezed them for discount after they service my car, as is the case with many pet owners at Toa Payoh Vets.
At the 4th time "Check coolant level," message flashed, I asked the mechanic whether he could do the job. I had to replace 2000 ml of water in 5 days after he had assured me that he had resolved my problem.
I cannot afford putting my car overnight and then encounter the same problem again. The old man pointed to some water spots on the radiator and said he knew what to do. He diagnosed the radiator cap as being damaged and therefore leaked the coolant. He said he had used pressure tests and there was no other leakage. Earlier he had put some liquid which could seal any cracks but they did not work.
Yet, I got the same problem. On the 5th time, he said he would check again. He said the 5-month-old German-made radiator was faulty and had replaced with a French-made radiator. The supplier of the German-made radiator would not provide a replacement and therefore I had to pay him $500. "The 'check coolant level' was reported within 2 months of getting the German-made radiator," I said. "I wish to speak to the distributor as he is selling faulty goods and cheating people." The old man said it was of no use. "I was referred to another mechanic down the road," I said to the old man. "You could not resolve my problem for so many times."
With the new radiator replaced, I checked the water level 5 days later. There was a need to top up 200 ml of water. So, was there a leakage or not? I have to wait and see.
My situation is similar with that of the Corgi owner as I entrusted my mechanic to resolve my problem. He recommended replacement of the radiator and some pumps and the bill came up to $7,000!
Only that she had consulted the same practice for over 10 times without resolution of her problems and I would not be surprised if she had spent $7,000 too. I did not ask her. But I could empathise with her.
DENTAL SCALING DONE TODAY
I use the same guideline for sedation
A 10-kg healthy young dog - 0.4 ml domitor + 0.5 ml ketamine IV
The Corgi weighed around 14 kg but she was old. Blood tests were normal but no chest x-ray of the heart was done today as this is the usual practice. In human anaesthesia, a chest x-ray at Singapore General Hospital where I went for surgery, was mandatory.
In this Corgi, I gave 0.1 ml domitor + 0.1 ml ketamine mixed with 0. 3 ml normal saline and gave IV. This was less than 20% of the formula but the dog was sedated 80%. I used isoflurane gas to top up.
"No need," my assistant Min said when I told him to apply a tourniquet.
"Sometimes it is not needed," I said. "But I see that you have wasted a lot of time in some cases where no tourniquet was used as the blood collection or injection was not possible at the first attempt."
The dog had a tourniquet and the cephalic vein was distended. The sedatives were given.
I monitored the isoflurane gas + oxygen very carefully as the lady owner entrusted me and expected the dog to be OK. Eyelid blinking to be zero and maintenance of isoflurane was 0.5 - 1%. The dog had bilateral cataracts but I could monitor the closing of the pupil. It still took 45 minutes to complete the whole dental scaling. Solid teeth. Tartar only esp. on PM4 upper, both sides.
The owner had said, "My dog had only one anaesthesia and that was when she was spayed." I said: "That was some 6 years ago and she was healthy then. I advise an X-ray of the chest."
ULTRASOUND OF THE BLADDER AND X-RAY OF THE CHEST AND ABDOMEN AT 11.30 AM
I collaborate with an experienced vet who did the ultrasound and X-rays. I brought the Corgi personally to discuss with him the use of the tools of the trade - the ultrasound and the X-rays and how he would interpret the results. I had wanted a contrast cystography involving injecting dyes into the dog and X-raying the kidneys and bladder to check for tumours and stones. However the cost of $500 inclusive of anaesthesia was above budget. I had to find other lower cost alternatives and in any case, there was anaesthesia which I had just performed during dental scaling in the morning.
To cut a long story short, the ultrasound showed lots of floating sandy particles inside the bladder as reported by previous vets doing the ultrasound. There was thickened bladder wall but no polyps or transitional cell carcinoma inside the bladder. "Otherwise the Doppler would show blood flowing into the mass on the inside of the bladder," the vet I collaborated with said to me. "There was zero blood flow and therefore the sandy particles were separate from any mucosa." Excellent use of the tools of the trade, I must commend him.
On X-rays, I could see radio-dense bladder indicative of struvites (as reported by urine tests by the previous vets). The owner collected urine in the morning but I had treated the dog with antibiotics 2 days ago. I wanted the X-ray to see if there were large struvite stones. There were none.
Lots of radio-dense sandy particles float inside the bladder. Could they be struvite sand or inflammatory cells?
Yet the urine test taken on the same day is negative for epithelial, white blood and red blood cells and crystals, mucus threads, yeast and bacteria.
The urine test I sent to the lab today show normal urine. Amber, clear, no nitrite, protein, glucose, ketones, urobilinogen (normal), bilirubin, blood. Urine microscopy - no white or ed blood cells, no epithelial cells, casts, crystals, bacteria, mucus threads. yeast or others.
The pH was 7.0 (5-8) and SG was 1.018 (1.0905-1.030).
Based on history, the sandy particles would be struvites or inflammatory cells.
I had to treat the dog 2 days ago as it was quite distressing for the owner. In any case, urine bacterial culture and sensitivity tests had been done by the other vets and Proteus mirabilis was found in one time. So, I did not repeat again to save the owner some money. Baytril had worked and the dog was no more passing blood in the urine while on antibiotics.
What is the next step now that the bladder is shown to be free from tumours and polyps which would cause recurrent UTI? I recommend dental scaling which was done. The next step would be SD diet for 3-4 months to acidify the urine. If this works, it will be happy days for the owner. I will use urine acidifiers and review the case in 4 weeks. Will I succeed where others fail? Only time will tell whether I can resolve the lady's pet problem of recurring UTI. This dog was well beloved as not many Singapore owners would bother to take the dog for over 10 times to treat for blood in the urine. One or two times and that's it for the old girl!
CONCLUSION
The history of the case reports from the other vets is much more important than one urine test. I would say that struvite and inflammatory cells are present.
The dog has chronic cystitis and recurrent UTI. Tumours have been ruled out as a cause. Blood test before antibiotic treatment was normal and so a other-source of infection via the blood is ruled out. This leaves struvites are a cause. The pH 7.0 is not acidic. Nor alkaline but this should be reduced to produce acidic urine to stop bacterial growth.
P.S. The dog's heart was enlarged but when I auscultated the heart, the heart sounds were normal. "Why is the heart enlarged?" the owner asked. "It may be due to old age or congenital or other reasons," I said. The dog did feel short of breath at certain times. Will update this webpage.
Updates will be at: Toa Payoh Vets webpage:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm
Monday, October 31, 2011
716. Sunday's interesting case. Oct 30, 2011. $600 for a rescue dog with tick fever
ANIMAL ACTIVISM
I got a text message from a young lady caring for a Singapore Rescue Group's stray dog with tick fever diagnosed by Vet 1. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever will be ineffective as this dog had Babesia gibsoni. Imizole is "ineffective" against Babesia gibsoni. The "effective" drugs will be the atovaquone, clindamycine and azithromycin but it will cost $1,000.
The rescue group asked her to top up the bill but she did not have the means to do so. So, she texted me for advice.
Below are some of my replies to her.
It is kind of you to do dog rescue work. There are many financial considerations.
Combination of oral atovaquone, clindamycine and azithromycin by (Vet 1) as said by you, is effective against Babesia gibsoni infections in this dog.
I will not comment further as I don't use these expensive drugs. Success rate depends on follow up, not just one injection. Blood transfusion 1.5 bags at $500/bag and hospitalisation will be more than $600 budget from the Rescue group.
Berenil is cheap but anaphylaxis according to your text. Hb at 5 is low for your affected dog, but you also need to know total RBC.
In conclusion, treatment is not cheap due to prolonged treatment and follow ups.
E-MAIL TO DR SING DATED Oct 29 (2 days ago)
Thank you very much Dr Sing. I am heading out to check on the dog this morning. If the rescue doesn't want to pay for treatment, I think I will bring the dog home to die as she doesn't like the cage...
Thanks again. Will email u soon.
Name given
COMMENTS
The dog was sent home without the expensive treatment or imizole. The lady activist thought that the dog was "alone" at the vet clinic and she would take the dog home to die. Berenil would be available possibly 2 days later.
Coincidentally, I was following up on an English cocker spaniel, 11.5 kg with Babesia gibsoni and ehrlichia tick fever 10 days ago.
She came today for her 2nd imizole injection (0.6 ml SC today, Sunday) 10 days after the first injection (0.5 ml SC). Based on her active normal behaviour and much pinker gums, the first imizole injection had worked. Otherwise she should be dead by now.
So, should Vet 1 have given imizole to that stray dog rather than wait for the cheaper Berenil to be available later? Is imizole totally ineffective against Babesia gibsoni? I related this matter of the stray dog to the cocker spaniel and she was worried that I had not given the correct treatment.
"Will you dog be active and rushing out and have pink gums 10 days after the first injection if imizole was ineffective?" I asked her as I gave the 2nd injection today.
My thoughts are for that stray dog. I had offered to give the imizole injection and help out with supportive therapy but the lady activist was a caregiver only and could not decide as she was not the paymaster.
MORE PICTURES AND UPDATES AT TOA PAYOH VETS WEBPAGE
http://www.sinpets.com/dogs/20111036babesia-gibsoni-treatment-drug-imizole-success-singapore-toapayohvets.htm
____________________________
I got a text message from a young lady caring for a Singapore Rescue Group's stray dog with tick fever diagnosed by Vet 1. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever will be ineffective as this dog had Babesia gibsoni. Imizole is "ineffective" against Babesia gibsoni. The "effective" drugs will be the atovaquone, clindamycine and azithromycin but it will cost $1,000.
The rescue group asked her to top up the bill but she did not have the means to do so. So, she texted me for advice.
Below are some of my replies to her.
It is kind of you to do dog rescue work. There are many financial considerations.
Combination of oral atovaquone, clindamycine and azithromycin by (Vet 1) as said by you, is effective against Babesia gibsoni infections in this dog.
I will not comment further as I don't use these expensive drugs. Success rate depends on follow up, not just one injection. Blood transfusion 1.5 bags at $500/bag and hospitalisation will be more than $600 budget from the Rescue group.
Berenil is cheap but anaphylaxis according to your text. Hb at 5 is low for your affected dog, but you also need to know total RBC.
In conclusion, treatment is not cheap due to prolonged treatment and follow ups.
E-MAIL TO DR SING DATED Oct 29 (2 days ago)
Thank you very much Dr Sing. I am heading out to check on the dog this morning. If the rescue doesn't want to pay for treatment, I think I will bring the dog home to die as she doesn't like the cage...
Thanks again. Will email u soon.
Name given
COMMENTS
The dog was sent home without the expensive treatment or imizole. The lady activist thought that the dog was "alone" at the vet clinic and she would take the dog home to die. Berenil would be available possibly 2 days later.
Coincidentally, I was following up on an English cocker spaniel, 11.5 kg with Babesia gibsoni and ehrlichia tick fever 10 days ago.
She came today for her 2nd imizole injection (0.6 ml SC today, Sunday) 10 days after the first injection (0.5 ml SC). Based on her active normal behaviour and much pinker gums, the first imizole injection had worked. Otherwise she should be dead by now.
So, should Vet 1 have given imizole to that stray dog rather than wait for the cheaper Berenil to be available later? Is imizole totally ineffective against Babesia gibsoni? I related this matter of the stray dog to the cocker spaniel and she was worried that I had not given the correct treatment.
"Will you dog be active and rushing out and have pink gums 10 days after the first injection if imizole was ineffective?" I asked her as I gave the 2nd injection today.
My thoughts are for that stray dog. I had offered to give the imizole injection and help out with supportive therapy but the lady activist was a caregiver only and could not decide as she was not the paymaster.
MORE PICTURES AND UPDATES AT TOA PAYOH VETS WEBPAGE
http://www.sinpets.com/dogs/20111036babesia-gibsoni-treatment-drug-imizole-success-singapore-toapayohvets.htm
____________________________
715. Follow up on puppy's paper training case
The puppy was paper-trained for 2 weeks and then given an extension of the confined area. Dettol was used. However, I need more info about the housing layout etc and the following are my comments:
E-MAIL TO DR SING DATED OCT 30, 2011
A@gmail.com to me
show details 8:22 PM (7 hours ago)
Hi Dr Sing,
It was nice meeting you and Dr Vanessa when I brought my puppy for his 3rd vaccination.
The puppy has been eliminating at the correct place, i.e. the newspaper, for about 2 weeks. We let him out occasionally to a small, confined area and he has no problems going back to the newspaper to pee. However, for the past few days, he has been peeing outside the newspaper a few times even after we washed the floor with Dettol. We took it that he forgot the place the first few times, but today, the newspaper was clean and he still peed outside the newspaper. Once, when he peed on the newspaper, he sat beside the newspaper and looked guilty. Are there any possible reasons to this?
Would appreciate your advise on this matter. Thank you.
Regards,
A
E-MAIL REPLY FROM DR SING DATED OCT 31, 2011
I was surprised to meet you and your mum and thank you for coming to Toa Payoh Vets.
Pl email 3 pictures of his housing layout including where you place his feed and water bowl and his sleeping bed (if any).
1. What is the pH of Dettol? Does it some ammonia urine-smell? This may cause the puppy to use the area as its toilet area and its crate as the clean den (although it has newspapers).
2. Previously, did you use Dettol?
3. Use white vinegar + water at 1 part vinegar to 3 parts water to clean the floor instead of Dettol.
4. It may be best to confine him again.
5. Pictures of the housing and other info as requested are needed.
Best wishes.
UPDATES AT TOA PAYOH VETS WEBPAGE
http://www.sinpets.com/F5/20111023puppy-toilet-training-paper-or-grate-not-both-singapore-toapayohvets.htm
E-MAIL TO DR SING DATED OCT 30, 2011
A@gmail.com to me
show details 8:22 PM (7 hours ago)
Hi Dr Sing,
It was nice meeting you and Dr Vanessa when I brought my puppy for his 3rd vaccination.
The puppy has been eliminating at the correct place, i.e. the newspaper, for about 2 weeks. We let him out occasionally to a small, confined area and he has no problems going back to the newspaper to pee. However, for the past few days, he has been peeing outside the newspaper a few times even after we washed the floor with Dettol. We took it that he forgot the place the first few times, but today, the newspaper was clean and he still peed outside the newspaper. Once, when he peed on the newspaper, he sat beside the newspaper and looked guilty. Are there any possible reasons to this?
Would appreciate your advise on this matter. Thank you.
Regards,
A
E-MAIL REPLY FROM DR SING DATED OCT 31, 2011
I was surprised to meet you and your mum and thank you for coming to Toa Payoh Vets.
Pl email 3 pictures of his housing layout including where you place his feed and water bowl and his sleeping bed (if any).
1. What is the pH of Dettol? Does it some ammonia urine-smell? This may cause the puppy to use the area as its toilet area and its crate as the clean den (although it has newspapers).
2. Previously, did you use Dettol?
3. Use white vinegar + water at 1 part vinegar to 3 parts water to clean the floor instead of Dettol.
4. It may be best to confine him again.
5. Pictures of the housing and other info as requested are needed.
Best wishes.
UPDATES AT TOA PAYOH VETS WEBPAGE
http://www.sinpets.com/F5/20111023puppy-toilet-training-paper-or-grate-not-both-singapore-toapayohvets.htm
Sunday, October 30, 2011
714. Follow up on dog enucleation case - pterygium and glaucoma case
On Sat, Oct 29, 2011 at 12:14 PM, ...@singnet.com> wrote:
Dear Dr Sing,
Queenie, the 12 year old dog, is doing well. She is eating and running around. Has no problems passing motion and easing herself.
Enclosed are the pictures you asked for. I suppose her stiches come out on the 2nd of Nov (14 days)
Thanks alot
regards
Thanks for pictures. 14 days should be OK to take out stitches. Best wishes.
Dear Dr Sing,
Queenie, the 12 year old dog, is doing well. She is eating and running around. Has no problems passing motion and easing herself.
Enclosed are the pictures you asked for. I suppose her stiches come out on the 2nd of Nov (14 days)
Thanks alot
regards
Thanks for pictures. 14 days should be OK to take out stitches. Best wishes.
Friday, October 28, 2011
FURTD, FIV and FeLV in cats
1. Feline upper respiratory tract diseases (FURTD) are usually caused by Feline herpes virus and calicivirus in 90% of the cases in Australia's multi-cat environments. In Singapore, usually stray cats.
Sneezing, pus in both nostrils and eye discharges are the main signs.
2. FIV
Feline Immunodeficiency Virus (FIV)
Transmission is mainly by biting e.g. roaming male cats.
Clinical 4 phases
1. Acute infection - 4-6 weeks, fever, neutropenia, lymphadenopathy
2. Asymptomatic carrier state (FIV Ab positive). Most common. last months or years.
3. Chronic disease. Non-specific signs like chronic stomatitis (possible immunodeficiency cause)
4.Terminal AIDS-phase. Infections and neoplasia.
Few cats go to Phase 3 and 4.
Hard to give prognosis.
Laboratory list is typical as follows:
neutropenia, thrombocytopenia, non-regenerative anaemia (use erythropoietin)
monocyotosis and lymphocytosis
renal azotaemia
ployclonal hyperglobulinaemia
ELISA test kits. detect anti-FIV antibodies
PROGNOSIS
Most cats don't develop FIV-associated disease, prognosis is generally good.
Keep cat inddors. FIV cats isolated in cattery. Good nutrition, proper sanitation and stress reduction.
Routine vaccination with inactivated vaccines
TREATMENT
Supportive treatment. prolonged or repeated antibiotics.
Anti-viral therapy
Erythropoietin
PREVENTION
Vaccine available. Roaming outdoor cat advised.
FIV and FeLV easily destroyed by disinfection and tranmission by fomites is unusual.
Prevent contact FIV+ to FIV-ve cats
regular deworming, clinical monitoring and preventive dental care
spay or neuter
Feline Leukaemia Virus (FeLV)
Mainly an infection of young cats cf. FIV cats older than 6 years usually. Non-specific signs like weight loss, anorexia, fever, depression.
Transmission mainly via saliva, nasal secretions during grooming, sharing of food or water sources.
Three outcomes
1. Transietn infection
2. Latency (sub-clinical)
3. Persistent viraemia.
Lympadenopathy (thymic and multicentric lymphoma most frequency associated with FeLV), ocular signs and anaemia YOUNG cats
Laboratory - non-specific
Anaemia
MOST common abnromality. non-regenrative
Leucoppenia, thrombocytopenia, haemolytic anaemia
Azotaemia (pre-renal or enal)
Hyperbilirubinaemia (pre-hepatic or hepatic)
ALT/AP increses
Proteinuria (secondary glomerulopathies or UTI)
Bacteruia
SPECIFIC TEST
ELISA antigen detection.
Other tests;
IFAT blood smears (antigen in WBC and platelets)
Virus isolation
TREATMENT
Supportive treatment ---- control secondary infections, restore hydration with fluid therapy and nutrition. blood transfusions in anaemic cats, doxycycline for FIA. Lymphoma treated with chemotherapy.
PREVENTION
Avoid exposure by contact.
FeLV is also a non-core vaccine,use in cats at risk e.g. cattery, outdoor, rehoming cats
PCR
Sneezing, pus in both nostrils and eye discharges are the main signs.
2. FIV
Feline Immunodeficiency Virus (FIV)
Transmission is mainly by biting e.g. roaming male cats.
Clinical 4 phases
1. Acute infection - 4-6 weeks, fever, neutropenia, lymphadenopathy
2. Asymptomatic carrier state (FIV Ab positive). Most common. last months or years.
3. Chronic disease. Non-specific signs like chronic stomatitis (possible immunodeficiency cause)
4.Terminal AIDS-phase. Infections and neoplasia.
Few cats go to Phase 3 and 4.
Hard to give prognosis.
Laboratory list is typical as follows:
neutropenia, thrombocytopenia, non-regenerative anaemia (use erythropoietin)
monocyotosis and lymphocytosis
renal azotaemia
ployclonal hyperglobulinaemia
ELISA test kits. detect anti-FIV antibodies
PROGNOSIS
Most cats don't develop FIV-associated disease, prognosis is generally good.
Keep cat inddors. FIV cats isolated in cattery. Good nutrition, proper sanitation and stress reduction.
Routine vaccination with inactivated vaccines
TREATMENT
Supportive treatment. prolonged or repeated antibiotics.
Anti-viral therapy
Erythropoietin
PREVENTION
Vaccine available. Roaming outdoor cat advised.
FIV and FeLV easily destroyed by disinfection and tranmission by fomites is unusual.
Prevent contact FIV+ to FIV-ve cats
regular deworming, clinical monitoring and preventive dental care
spay or neuter
Feline Leukaemia Virus (FeLV)
Mainly an infection of young cats cf. FIV cats older than 6 years usually. Non-specific signs like weight loss, anorexia, fever, depression.
Transmission mainly via saliva, nasal secretions during grooming, sharing of food or water sources.
Three outcomes
1. Transietn infection
2. Latency (sub-clinical)
3. Persistent viraemia.
Lympadenopathy (thymic and multicentric lymphoma most frequency associated with FeLV), ocular signs and anaemia YOUNG cats
Laboratory - non-specific
Anaemia
MOST common abnromality. non-regenrative
Leucoppenia, thrombocytopenia, haemolytic anaemia
Azotaemia (pre-renal or enal)
Hyperbilirubinaemia (pre-hepatic or hepatic)
ALT/AP increses
Proteinuria (secondary glomerulopathies or UTI)
Bacteruia
SPECIFIC TEST
ELISA antigen detection.
Other tests;
IFAT blood smears (antigen in WBC and platelets)
Virus isolation
TREATMENT
Supportive treatment ---- control secondary infections, restore hydration with fluid therapy and nutrition. blood transfusions in anaemic cats, doxycycline for FIA. Lymphoma treated with chemotherapy.
PREVENTION
Avoid exposure by contact.
FeLV is also a non-core vaccine,use in cats at risk e.g. cattery, outdoor, rehoming cats
PCR
712. Update: In 2008, tick fever in a Great Dane
A veterinary-client relationship of trust and respect benefits this Great Dane
"My Great Dane does not eat even his favourite curry chicken rice. He is tired and has pale eyelids for at least 2 days. Is it possible he has tick fever?" Jenny phoned me. "I removed some ticks from him recently."
She was my ex-veterinary nurse some 20 years ago and has at least 20 years of handling dogs and cats in various employment in boarding, veterinary practice, breeding and retail. She started work with animals since she was 18 years old and has hands-on experiences in dog diseases in Singapore.
Jenny continued: "The Great Dane has no appetite and sleeps a lot for the past 2 days. He looks pale in his gums. Can it be tick fever? Can you make a house-call?" the caregiver asked me.
"Jenny, if you think it is tick fever, bring the dog to the Surgery. There is no point making a house-call as it is much easier to treat him in the Surgery." I advised this busy manager of a large pet accessory warehouse retail shop in Pasir Ris.
"Can I come tonight?" the caregiver wanted to clear her administrative and paper work first.
"If you think he has tick fever, do not delay treatment," I needed no explanation that every delay permitted the blood parasites to multiply and destroy the blood cells.
"I will get a pet transport man to bring the dog down to the surgery. If it is the starting of tick fever, come down now to get the dog treated before the blood parasites multiplying in his red blood cells overwhelms and kills him," I advised.
Jenny arrived at 3 pm with an assistant. She is a gentle soft-voiced lady in her forties. I was surprised that her hair was disheveled while multiple frown lines creased her face. The 2.5-year-old male giant canine came down from Jenny's car and sauntered into the Surgery. He had never been sick and therefore had not been to the veterinary surgery for the past 2 years. He was as tall as a 12-year-old child.
Fever of 40.2C was confirmed by taking the rectal temperature. There was moderate pallor of gums and conjunctiva.
Two men carried the giant onto the table. He weighed around 80 kg.
Complete blood count needed. I/V antibiotics and amino acids given. Sent home with the i/v catheter in his vein.
Care-giver wants the dog home to treat herself
Put catheter IV inserted. 3 blood samples to be sent to the laboratory. IV dextrose saline, duphalyte and baytril IV given. Sent home with bottle of 5% dextrose saline and duphalyte on slow IV drip. Dog could still walk home. He looked normal.
Wednesday Aug 20, 2008
Not eating much. Lethargy. No news from caregiver.
Pancytopenia in blood test result - Low red, white blood cells and platelets. Based on laboratory tests, the Great Dane should not be standing and should be bleeding to death. But he could be at the start of the acute stage of Tick Fever and the parasites were just destroying his blood cells. Was there any hope for him?
Thursday Aug 21, 2008 house-call by vet
Phoned caregiver. Not really improved. Still not eating much. I told caregiver I would need to make a house-call to check and give anti-babesiosis injection. What I said was all Greek to the caregiver.
Vet needs to do a house call. The busy caregiver did not update the vet.
Caregiver cooked liver. She gave a few bags of fluid and lots of multivitamins to the Great Dane for the past 2 days.
"Dog looks normal," his gentleman owner said. "No pallor of tick fever."
The Great Dane remembered the injections and drips at the vet and ran into the safety of his home.
The Great Dane reluctantly said goodbye to me since his caregiver asked him to do it. Given anti-babesia injection on Aug 21, 2008 before I left the Great Dane's residence. He had not recovered fully as at Aug 25, 2008. Jenny was advised to monitor his rectal temperature. She needed to buy a thermometer.
The caregiver was cooking liver. Dog ate when caregiver hand-fed bits of liver. Caregiver showed me that she had bought 0.9% Sodium Chloride from a general practitioner and 5% dextrose bag from somewhere. She would give the solutions by SC. I gave 2.6 ml Imizole SC. Duphalyte x 1 bottle to caregiver. Advised caregiver to come for more vibravet medication on completion of 7 days' course and buy a thermometer.
Friday Aug 22, 2008
Great Dane not really interested in food.
"No time to buy the thermometer," caregiver said.
"Did you check on how much water the Great Dane drink and what is the colour of his urine?" I asked.
"You know, I have been very busy updating price list of goods nowadays," she said. "I also cooked for the dog. I do not have time to monitor how much water he drinks or the colour of his pee!" The cost of goods must increase as there was a surge in food, petrol and other prices in the past week and the caregiver was responsible to get the updates done before the weekend sales. The Great Dane had to fall sick and took up a lot of her time.
"Blood tests for Babesia and Ehrlichia at the AVA would cost $200. Do you want them?" I asked the caregiver. She was hesitant about the costs involved. As I have had given the Great Dane the important treatment for the two types of parasites causing tick fever, I said, "Wait and see".
Tuesday Aug 26, 2008
"Great Dane asked to be bathed today," Jenny phoned me. "I need to come down to your surgery to get the vibravet tablets". Surprisingly the caregiver remembered as she had a lot of paperwork to do and I did expect her to forget about the medication as most owners will do. After all, the Great Dane is now eating and medication had been given for 7 days.
"When did the Great Dane recover?" I asked as I did not pester Jenny since the last call. She said she had some much paper work to do the last time I phoned her. Nowadays, a capable and intelligent hardworking employee does the work of 3 people and work never ends for the good employee.
Jenny said, "On Sunday, the Great Dane was so hungry and wolfed down his food."
"It must be due to Imizole and medication," I forgot to acknowledge caregiver's important role.
"It is due to my extra vitamins and cooking of liver for him." Jenny replied. Sometimes veterinarians look at the cause and effect of drugs rather than the acknowledgement of the care, time spent and love of the caregiver when the case is closed successfully.
Her boss came to the surgery to get vibravet for 10 more days as Jenny was busy updating the pricing of pet products. "Go and buy two thermometers," I said to the boss. "Jenny has been too busy to buy one. The thermometers can help to monitor the fever of your sick dogs." Jenny monitored the fever by feeling whether the belly of the Great Dane was hot to the hand or not. That was not a good way to do it.
Conclusion
It is important for the vet to follow up on suspicious tick fever cases. As there was a relationship of trust and respect, I made a house-call to give the Great Dane the anti-Babesia injection after reviewing his blood panel tests. There was no time to wait for the specific blood tests to confirm the presence of the blood parasites which may or may not be present.
This caregiver was extremely good in the nursing care of the Great Dane and a great asset to her boss. A relationship of trust and respect between the caregiver and the veterinarian is always beneficial to the pet. If there was no such relationship, I doubt I would dare to do the house-call as a follow up on the first treatment.
UPDATES
This case is probably an acute tick fever. Although the blood parasites were not isolated nor was a blood smear done due to financial considerations, the blood test of low blood cells and platelets is suggestive of an acute tick fever. Aggressive treatment is necessary to prevent recurrence of fever. No further treatment was requested by the owner.
As at Sep 10, 2008, the Great Dane was normal. He lived for a few more years and passed away suddenly around 2010.
Acute Tick Fever in dogs is hard to diagnose as there are no specific signs. Lethargy, fever and loss of appetite may be the only signs. As these are non-specific symptoms, diagnosis of tick fever is often missed.
Blood parasites such as Ehrlichia canis and Babesia canis (protozoa) destroy the white and red blood cells respectively.
Haematolgy. Blood tests can be very useful in aiding the diagnosis of tick fever. In this case, the Great Dane had very low white cell, red cell and platelets. Test for Ehrlichia titres and babesia are available at the AVA (Agri-Food and Veterinary Authority) laboratory. The cost for both is around S$200.00. 5 ml blood in plain tubes is needed. However, the client did not want the blood tests done.
Subclinical Tick Fever (no signs) can exist in the dog for years. Then it becomes Chronic Tick Fever (severe anaemia, bleeding from nose, kidneys and intestines to death). Most cases of tick fever are diagnosed at the chronic stage.
Doxycycline oral tablets and Imizole (imidocarb) injection are drugs of choice for the treatment of tick fever. Avoidance of ticks by using fipronil, permethrin and amitraz are best as there is no known vaccine available.
In this case, financial considerations prevent me from following up to check the elimination of the parasites or any carrier status.
More pictures at:
Toa Payoh Vets
Report at:
http://www.bekindtopets.com/dogs/20080839Great_Dane_Tick_Fever_ToaPayohVets.htm
"My Great Dane does not eat even his favourite curry chicken rice. He is tired and has pale eyelids for at least 2 days. Is it possible he has tick fever?" Jenny phoned me. "I removed some ticks from him recently."
She was my ex-veterinary nurse some 20 years ago and has at least 20 years of handling dogs and cats in various employment in boarding, veterinary practice, breeding and retail. She started work with animals since she was 18 years old and has hands-on experiences in dog diseases in Singapore.
Jenny continued: "The Great Dane has no appetite and sleeps a lot for the past 2 days. He looks pale in his gums. Can it be tick fever? Can you make a house-call?" the caregiver asked me.
"Jenny, if you think it is tick fever, bring the dog to the Surgery. There is no point making a house-call as it is much easier to treat him in the Surgery." I advised this busy manager of a large pet accessory warehouse retail shop in Pasir Ris.
"Can I come tonight?" the caregiver wanted to clear her administrative and paper work first.
"If you think he has tick fever, do not delay treatment," I needed no explanation that every delay permitted the blood parasites to multiply and destroy the blood cells.
"I will get a pet transport man to bring the dog down to the surgery. If it is the starting of tick fever, come down now to get the dog treated before the blood parasites multiplying in his red blood cells overwhelms and kills him," I advised.
Jenny arrived at 3 pm with an assistant. She is a gentle soft-voiced lady in her forties. I was surprised that her hair was disheveled while multiple frown lines creased her face. The 2.5-year-old male giant canine came down from Jenny's car and sauntered into the Surgery. He had never been sick and therefore had not been to the veterinary surgery for the past 2 years. He was as tall as a 12-year-old child.
Fever of 40.2C was confirmed by taking the rectal temperature. There was moderate pallor of gums and conjunctiva.
Two men carried the giant onto the table. He weighed around 80 kg.
Complete blood count needed. I/V antibiotics and amino acids given. Sent home with the i/v catheter in his vein.
Care-giver wants the dog home to treat herself
Put catheter IV inserted. 3 blood samples to be sent to the laboratory. IV dextrose saline, duphalyte and baytril IV given. Sent home with bottle of 5% dextrose saline and duphalyte on slow IV drip. Dog could still walk home. He looked normal.
Wednesday Aug 20, 2008
Not eating much. Lethargy. No news from caregiver.
Pancytopenia in blood test result - Low red, white blood cells and platelets. Based on laboratory tests, the Great Dane should not be standing and should be bleeding to death. But he could be at the start of the acute stage of Tick Fever and the parasites were just destroying his blood cells. Was there any hope for him?
Thursday Aug 21, 2008 house-call by vet
Phoned caregiver. Not really improved. Still not eating much. I told caregiver I would need to make a house-call to check and give anti-babesiosis injection. What I said was all Greek to the caregiver.
Vet needs to do a house call. The busy caregiver did not update the vet.
Caregiver cooked liver. She gave a few bags of fluid and lots of multivitamins to the Great Dane for the past 2 days.
"Dog looks normal," his gentleman owner said. "No pallor of tick fever."
The Great Dane remembered the injections and drips at the vet and ran into the safety of his home.
The Great Dane reluctantly said goodbye to me since his caregiver asked him to do it. Given anti-babesia injection on Aug 21, 2008 before I left the Great Dane's residence. He had not recovered fully as at Aug 25, 2008. Jenny was advised to monitor his rectal temperature. She needed to buy a thermometer.
The caregiver was cooking liver. Dog ate when caregiver hand-fed bits of liver. Caregiver showed me that she had bought 0.9% Sodium Chloride from a general practitioner and 5% dextrose bag from somewhere. She would give the solutions by SC. I gave 2.6 ml Imizole SC. Duphalyte x 1 bottle to caregiver. Advised caregiver to come for more vibravet medication on completion of 7 days' course and buy a thermometer.
Friday Aug 22, 2008
Great Dane not really interested in food.
"No time to buy the thermometer," caregiver said.
"Did you check on how much water the Great Dane drink and what is the colour of his urine?" I asked.
"You know, I have been very busy updating price list of goods nowadays," she said. "I also cooked for the dog. I do not have time to monitor how much water he drinks or the colour of his pee!" The cost of goods must increase as there was a surge in food, petrol and other prices in the past week and the caregiver was responsible to get the updates done before the weekend sales. The Great Dane had to fall sick and took up a lot of her time.
"Blood tests for Babesia and Ehrlichia at the AVA would cost $200. Do you want them?" I asked the caregiver. She was hesitant about the costs involved. As I have had given the Great Dane the important treatment for the two types of parasites causing tick fever, I said, "Wait and see".
Tuesday Aug 26, 2008
"Great Dane asked to be bathed today," Jenny phoned me. "I need to come down to your surgery to get the vibravet tablets". Surprisingly the caregiver remembered as she had a lot of paperwork to do and I did expect her to forget about the medication as most owners will do. After all, the Great Dane is now eating and medication had been given for 7 days.
"When did the Great Dane recover?" I asked as I did not pester Jenny since the last call. She said she had some much paper work to do the last time I phoned her. Nowadays, a capable and intelligent hardworking employee does the work of 3 people and work never ends for the good employee.
Jenny said, "On Sunday, the Great Dane was so hungry and wolfed down his food."
"It must be due to Imizole and medication," I forgot to acknowledge caregiver's important role.
"It is due to my extra vitamins and cooking of liver for him." Jenny replied. Sometimes veterinarians look at the cause and effect of drugs rather than the acknowledgement of the care, time spent and love of the caregiver when the case is closed successfully.
Her boss came to the surgery to get vibravet for 10 more days as Jenny was busy updating the pricing of pet products. "Go and buy two thermometers," I said to the boss. "Jenny has been too busy to buy one. The thermometers can help to monitor the fever of your sick dogs." Jenny monitored the fever by feeling whether the belly of the Great Dane was hot to the hand or not. That was not a good way to do it.
Conclusion
It is important for the vet to follow up on suspicious tick fever cases. As there was a relationship of trust and respect, I made a house-call to give the Great Dane the anti-Babesia injection after reviewing his blood panel tests. There was no time to wait for the specific blood tests to confirm the presence of the blood parasites which may or may not be present.
This caregiver was extremely good in the nursing care of the Great Dane and a great asset to her boss. A relationship of trust and respect between the caregiver and the veterinarian is always beneficial to the pet. If there was no such relationship, I doubt I would dare to do the house-call as a follow up on the first treatment.
UPDATES
This case is probably an acute tick fever. Although the blood parasites were not isolated nor was a blood smear done due to financial considerations, the blood test of low blood cells and platelets is suggestive of an acute tick fever. Aggressive treatment is necessary to prevent recurrence of fever. No further treatment was requested by the owner.
As at Sep 10, 2008, the Great Dane was normal. He lived for a few more years and passed away suddenly around 2010.
Acute Tick Fever in dogs is hard to diagnose as there are no specific signs. Lethargy, fever and loss of appetite may be the only signs. As these are non-specific symptoms, diagnosis of tick fever is often missed.
Blood parasites such as Ehrlichia canis and Babesia canis (protozoa) destroy the white and red blood cells respectively.
Haematolgy. Blood tests can be very useful in aiding the diagnosis of tick fever. In this case, the Great Dane had very low white cell, red cell and platelets. Test for Ehrlichia titres and babesia are available at the AVA (Agri-Food and Veterinary Authority) laboratory. The cost for both is around S$200.00. 5 ml blood in plain tubes is needed. However, the client did not want the blood tests done.
Subclinical Tick Fever (no signs) can exist in the dog for years. Then it becomes Chronic Tick Fever (severe anaemia, bleeding from nose, kidneys and intestines to death). Most cases of tick fever are diagnosed at the chronic stage.
Doxycycline oral tablets and Imizole (imidocarb) injection are drugs of choice for the treatment of tick fever. Avoidance of ticks by using fipronil, permethrin and amitraz are best as there is no known vaccine available.
In this case, financial considerations prevent me from following up to check the elimination of the parasites or any carrier status.
More pictures at:
Toa Payoh Vets
Report at:
http://www.bekindtopets.com/dogs/20080839Great_Dane_Tick_Fever_ToaPayohVets.htm
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