1206. Closed pyometra in an old Shih Tzu X

Dec 6, 2012
Ideally, it is best to use evidence-based medicine to get a diagnosis of closed pyometra. X-rays and blood tests are what the vet professors teach the new graduates.

However, in real life, there are clients who can't afford the tests. In this case, I usually get a good history and abdominal palpation of a big swollen uterus and operate to remove the uterus. There is always a possibility of no pyometra but a swollen bladder or an abdominal mass but economics prohibit more exploratory tests.

"It is how you present your case," I said to Dr Daniel. "If the owner has budget constraints, two X-rays add to the vet costs. There is a big orange-sized swelling in the abdomen. It could be the bladder but you said Mr Min had seen much urine being passed. Therefore, this globular swelling could be the uterus distended with pus."

The owner did not know when the last heat occurred. However there was vomiting yesterday and a complaint of sticky matter in the "urine." The dog was not eating much for the last 10 days. These clues point to pyometra. X-rays and blood tests will confirm.

The owner decided on X-rays.

There is closed pyometra, according to the X-rays. The uterus had swollen so much that the intestines were displaced forwards.

"Don't operate immediately," I said. "Give the IV drip and antibiotics 24 hours and operate after that. This ensures a better chance of survival, in my experience."

The owner will discuss further at around 7pm. There is no alternative but surgery to cure this dog. However, there is financial hardship for some owners and the newly graduate vet must the heartlander economics and provide the least cost surgery.


---------------------------------------------
Friday. Dec 7, 2012. The dog is better after IV drips yesterday but the rectal temp is below normal at 37.7 C.


The owner agreed to a blood test.
1. Kidney disorders. Urea 22  (4.2-6.3). Creatinine 188 (89-177).
2. Total WCC 62 (6-17) with N=98%. L=1.7%, M 0.3%. E & B =0%
3. Platelets 191 (200-500).
4.  Haemoglobin 9.9  (12-18)
5.  Red cell count 4.8  (5.5-8.5)

Surgery is necessary today but the risks are high as the dog has septicaemia and may die on the op table.

1205. Mynamar stories - An unhappy girl

On one afternoon in Dec 2012, I was at the office of Khin Khin Employment Agency. A thin fair lady in her late 20s came into the office to ask her to find an employer after working 6 months with the present employer who had told her that her services would end on Dec 15, 2012.

"Why do you want to spend more money in agency fees when you have a job now. You just put back $500 into your POSB account, apologise to your employer and complete your S pass contract," Khin Khin said loudly. "You should not have taken out the money as your boss had told you not to."

I was surprised that she could be sacked just for this $500. "Can you find the $500 to put back into the account?" I asked. "How much agency fee did you pay to get this job?" She said she had the money and had paid $4,500 agency fee.

"How much are you getting?" I asked. She said she got a good pay but she could not tolerate being scolded by her boss and colleagues.
"How many days off per month do you get?" I asked.
"4 days off," she said.
"So you have a good working condition," Khin Khin and I said. But there must be more to it than the $500 disobedience. I tried to help her by asking for her boss phone number since Khin Khin might not have the patience or ability to salvage this job loss situation with a Singapore employer.

The girl did not have the phone number. So I surfed the internet, got the company name and phoned the mobile number displayed.  It was her boss. "Who are you?" she asked me. "I am Dr Sing from Toa Payoh Vets," I said. "I am just trying to help your employee who said she would put back the $500 into the savings account and I hope she would get her job back."

"It is not the $500 which she already withdrew since the first month of work. Her agent had talked to her and I had waited for 6 months but her work attitude was bad. She swept the dirt under the table and this is 'pantung' (bad luck) to a Peranakan. She also smashed the curry puffs. I have given her Dec 15 as her last day and she has one month to look for an employer."

So this was an unhappy girl who had her first job in Singapore. A job so difficult to get nowadays as the Government clamped down on approvals even for employers who have the quota. Just a rejection letter for most employers. And there are so many young Myanmar ladies who are looking for a job in Singapore to support their families and to improve their standard of living. Yet, this unhappy girl showed her tantrums and misconduct.

She nodded her head when I told her that she had swept the dirt under the table and smashed the curry puffs in anger. "You must be from a rich Myanmar family," I said. Spending $4,500 on agency fees and more expenses just to get a job in Singapore cannot be affordable to the average Myanmar girl. "No, I am not", she said. A graduate in Myanmar with a good command of English and good looks may earn US$300-500 per month in a big company. It is just not easy to get a job in Yangon for higher pay. There are 60 million people in Myanmar and competition for jobs must be much more intense unlike the young Singaporean counterparts who can pick and choose their employer.

Poor work attitude afflicts many from the younger generation in their first job when the employment vacancies are high. As for this unhappy girl, I don't see any hope of her getting another job as there will be newer girls with no "leaving the Singapore employer before the end of contract - a red flag for employers" arriving in Khin Khin's office to look for jobs. Many of them can converse in good English and Mandarin, esp. from the Kachin State which is near to China.
P.S. According to one Myanmar lady in her 50s, she said that the Myanmar government stopped the teaching of English in primary schools in 1962. Those who studied English were ridiculed. So, the new generation of Myanmar nationals can't speak English proficiently.

1204. Integrity, meticulousness and bungling

Some young men are accident prone. I know of one young man. Whenever he plays football, he ends up with broken toe nails and lameness most of the time. I was surprised to encounter another young man in a similar predicament.This young man wanted to study vet medicine and he interned at my place. He got As for O level and is in a top Junior College and so he should be an intelligent young man.

Yet some forces affect his work as an intern.
One day, I asked him to pull out the plastic tab of the IV drip bottle as part of his hands on work. It is like pulling the metal tab of a can of Coke. I had already said he is a bungling person. He pulled the ring. The ring came off but the circular plastic cover still covers the IV drip bottle. It is like pulling out the ring of the Coke can but you can't drink because the circular piece didn't come off.

On another occasion, he showed me a video production. I encouraged interns to do it. "How come you showed the owner going away from Toa Payoh Vets when he is supposed to enter the Surgery to consult the vet?". He said: "Nobody will know. It is done in movies."

"Integrity of a production or any work process is very important," i said. "You think viewers are stupid but many will point this out. I don't want this Toa Payoh Vets video to be a multi-media class-room case study of the lack of integrity in production. In the National Service, we call bungling person cocked up." The young man laughed. Somehow fate seemed to be against him.

So he changed the scene. The video now showed the owner walking the dog into the Surgery to consult the vet. Great. "But how come the owner coming to see the vet wears a blue T-shirt and yet in the consultation room, he wears a yellow shirt?"  There is a need to be meticulous in a person's work esp. for a top school student.

After producing the video, he asked me to view it. I could see that the wording "subtitle/text" appeared again."Something wrong with the software," he said to me.

In the end, no video was produced.  A lot of time was spent by me too.

Follow up: Golf ball lump in a Golden Retriever's face

Dec 4, 2012  9.23 am

I reviewed the surgical case done on Oct 14, 2012. Not possible to talk to the busy owner for long but he said dog is OK and would check if the nylon stitches have been removed.
Golden Retriever, M, 9 years, 27kg

Blood test -  Total WCC = 5.2 (6-17) which is low. N=63% OK, L=22%, M 8%, E6%, B1%. Surprisingly in June 4, 2012, the Total WCC = 3.3 which was lower. N=55%, L 28%, M 11% E4%, B2%. Platelets 110 (200-500). The dog came in for vaccination and health check and there was no complaint of ill health. This dog is very selective in eating.

PRE-OP
24 hours before surgery, IV drip and antibiotics

ANAESTHESIA
Not a fit candidate for anaesthesia as Total WCC is low and the dog is old and thin. Short surgery, the better chance of survival.

SURGERY
Electro-surgery controls bleeding better. Still time between first skin incision and last stitch took 57 minutes and isoflurane gas time = 85 minutes. Xylazine 1.3 ml + Ketamine 0.3 ml  IV provides ineffective sedation. Needed isoflurane gas mask top up.  Nylon 2/0 x2 packets. PDS 2/0 x 1 packet used.

HISTOPATHOLOGY.  Granulation tissue either due to ulcer or wall of abscess. Had eaten chicken bones which could have pierced the cheek muscles.   

CONCLUSION
Blood test is useful in health screening pre-op. Still, there is need to be speedy, accurate and completeness in surgery.

As at Dec 5, 2012, owner said dog is OK.

   

1202. Compliance issues in bladder stone prevention in a British Bulldog

Dec 4, 2012. I phoned the owner of the British bulldog, female, 4 years today as part of follow-up.
An interesting multi-lobed large globular bladder stone was removed by Dr Daniel on Nov 26, 2012 and the stone is being analysed.

"My dog is OK but now passes stools every 2 days, as if she is constipated," the owner said. The dog used to eat like a horse.
"How many cans of S/D do you feed/day?" I asked as this 19 kg dog should be eating 1 and 1/2 to 1 and 3/4 cans per day.
"I feed 2/3 cans/day to prevent her from being fat."
"Do you feed dog treats, bread or other food?" I asked.
"Some vegetables and fruits, but only occasionally," she said.

COMPLIANCE ISSUESOwners don't comply with strictly feeding on prescription diet. They will give some treats, bread and fruits after a while.

REVIEWS FOR URINARY TRACT INFECTIONS
Owners don't do that.

1. To prevent struvites, urinary pH = 6.2 to 6.42. To prevent calcium oxalates, urinary pH = 7.1 to 7.73-weekly urine analysis is recommended but no Singapore owners do that. Breeds like Schnauzers and Shih Tzus have a tendency to get urinary stones and reviews of UTI will have prevented costly surgeries.

STRUVITES.  Use C/D after stone removal.  S/D is to dissolve the stones.
CALCIUM OXALATE.  Use U/D to prevent more calcium oxalate stone formation. U/D does not dissolve the stones.
  Check for urinary pH

CASE STUDY OF THE BRITISH BULLDOG
Nov 19, 2012. Blood in the urine for past 2-3 days. Urine analysis and X-rays (bladder stone).
Nov 26, 2012. Cystostomy to remove the stone. Bladder wall thickened. Dr Daniel put one appositional continuous suture  on submucosal layer and one inverting suture. I advised an additional layer of inverting suture as that would be what I would do. A urinary catheter could be used via urethra to pump saline into the bladder to check whether there is leakage but for 3 layers, I know that the closure is secure.

URINE ANALYSIS 2 TIMES
Nov 19, 2012.  pH 8.0, SG 1.020, Pn 2+, Blood 4+, WBC 30, RBC 720, Bacteria Nil, Crystals Nil   (history of haematuria for past 3 days only).
Nov 26, 2012. pH 8.0, SG 1.019, Pn 3+, Blood 4+, WBC >2250, RBC >2250, Bacteria 3+, Crystals triple phosphate occasional (history of haematuria for past 10 days). The dog was on trimax and medazole oral for 10 days and baytril injection. S/D X6 cans were fed.

Antibiotic sensistivity test not done.

POST OP
Stone analysis pending.
Oral Baytril 2 days, trimax bid x 10 days
S/D given but owner fed only 2/3 can per day instead of 1 and 1/2 or more.

OUTCOME
Dog active, no blood in the urine. Owner is happy.
Need to follow up to ensure compliance with C/D diet and check of urine for UTI and pH = 6.2 to 6.4.
It is time-consuming to follow up but owners don't comply and recurrence due to certain breed can recur again.

PHONED OWNER 10.35AM
1. Switch to dry C/D
2. Give 1 and 1/2 can of S/D per day for 20 kg bulldog till the switch to C/D.
2. No home-cooked rice or vegetables for at least next 6 months 
3. Urine analysis every month.

Whether she will comply is up to her.

-----------------------------------------------------------------------------------------------------------------------------
X-rays in the previous first report: Blog No. 1186
is at:
http://2010vets.blogspot.sg/2012/11/1186-haematuria-in-british-bulldog.html and the report is reproduced below:


Monday, November 19, 2012


1186. Haematuria in a British bulldog. Durian seed, bladder stone or a botched up spay?

"Could it be a durian seed? My dog rushed and swallowed one yesterday, before I could stop her," the be-spectacled woman in her late 40s was not fully convinced that the X-ray showed a big bladder stone in the ventral dorsal view was really a bladder stone. Her 4-year-old spayed female British bulldog had peed blood in the urine for the past 2 days.



"There is a lot of food in the stomach and intestines," I said. "It is hard to see the durian seed. Definitely, the stone is a large bladder stone. Have you been feeding dry dog food for the past 4 years?"



"No, I stopped after she was over one year old because the other vet advised me to feed home-cooked food to resolve the skin disease problem. I only gave her the dry food in the last 2 days when she passed blood in the urine. Could it be a botched spay operation done by Vet 1 when she was one year old? When she passed urine, I could see the blood in the urine."



"If the spay had not been well done, the dog would be passing blood without any urine every 6-monthly. The blood would not just be present together with the urination." I said.



"I do not see such occurrences," she said. "How about the durian seed? I forgot to tell Dr Daniel about it earlier."



"There may be a durian seed but it is not seen in the X-ray," I said. "The big mass is the bladder stone in the bladder."



I advised antibiotics for 3 days before surgery. The owner brought her trolley and dumped her Bulldog upright inside it and took her home today. The urine analysis and blood test results are pending.

SEE ABOVE CASE REPORT FOR DEC 2012 FOLLOW UP

1201. Sunday Dec 2, 2012's interesting cases

Sunday Dec 2, 2012
A bright sunny Sunday morning. Yesterday, a hamster with a "quail-egg sized" swelling in the right pouch area was admitted by Dr Jason and referred to me. Before I left the  surgery and handing over to Dr Jason, I saw a family bringing in a hamster.

I told him that tumours in hamsters should be passed to me if he does not want to operate to remove them. Giving medication would not reduce the big tumours.  Some could be abscesses but they had to be lanced. This is the correct approach.

Mr Min showed me the dwarf hamster, 2 years old, male. He had the biggest ovoid lump as hard as a hard-boiled egg.  "It could be an impacted food pouch on the right side," I said to Dr Daniel. "It is quite common. A broken seed could have lacerated the pouch and all the food got stuck inside."

We gave the hamster isoflurane gas inside a bottle. The hamster felt  sleepy. I took a pair of forceps  to evacuate the contents inside the right food pouch. Nothing came out. The hamster protested as he woke up quite easily under gas. Suddenly his eyes popped out from the sockets. "Stop every procedure,"  I said. "Let  the hamster recover. Any handling may cause death."       

After 5 minutes, Dr Daniel commenced gas anaesthesia and surgery. "Use the smallest scalpel blade and make a 0.5-cm cut on the skin," I had earlier asked Mr Min to clip off the hair and clean the area.

"It's a red tumour," I saw a bulging swelling  under the skin. "Extend the incision to 1.5cm long and shell out the tumour. There is usually a large blood vessel supplying this tumour.  Clamp "

1201. Follow up: The kidney-stone Schnauzer vomits again when at home.

"Unless the kidney is removed, it is not possible to prevent infections of the blood and urinary tract system," I said to the owner who had taken the dog back. The dog had a high total white cell count, blood and bacteria in the urine again. She was on intensive ciprobaby (twice) IV at 50ml/time (100 ml bottle) and had recovered during the past 3 days.

But she vomited again when she went home yesterday.She was active and Ok in the day time.

1199. Customised trained security dog services

Dec 3, 2012

Today, I met a 60-year-old retiree who accompanied her teenaged daughter to bring the 9-year-old Shih Tzu to me for general check up and vaccination.

"I have to ask my dad first as he is paying for the tests," the daughter said to me when I advised a blood and urine test for her old dog as part of health screening and this was not done before.

The dog had dental scaling done by Dr Vanessa last year and the teeth are OK, with some tartar formation. This dog does not permit his mouth to be opened and he showed his warning fangs when I attempted later. "He is a good natured dog as long as you don't touch his mouth," the girl told me. "He trembles and shakes when there is lightning and thunderstorm. A vet told us to ignore him but we hold him."
"You are fortunate that this dog does not pace and go into a frenzy during thunderstorms and lightning. He just shivers. Maybe de-sen. sitation using thunderstorm audio may help, by letting him listen regularly. But you may need to duplicate the change in temperature and humidity during thunderstorms and this cannot be done."

So, there was no solution.

However, the father has been working as a security consultant part-time, doing training programmes from his home. "Does he supply trained military guard dogs?" I asked her.  "In Singapore, the system is to send staff from the police and army to Europe or USA to buy puppies and train them for narcotics and other duties by the local staff. The success rate is extremely poor. The staff has to travel far distances to see one or two puppies in various parts of Europe. I doubt the breeders really sell the good ones. Then, there is the allegation of staff corruption."

So, the girl's father could provide a niche service as his contacts in China can provide trained dogs according to the buyer's requirements. For example, if the Customs want 50 sniffler dogs, he can arrange for them to be delivered fully trained and tested by the Buyer. "This is a niche market," I said to the father.

"Not much business as Singapore and Malaysia don't buy many. A dog lasts 4 years and the Police may replace less than 10 per year."

"Well, this is a niche market to be developed by you since you have the training source and dogs in China," I said. "In the past, there is no such establishment and now you have the specialised dog training school, you can supply customised-trained dogs to anybody. Not only the army or the military. For example, a rich father may wish to get a guide dog for his blind child. This will be your niche market. You need to start your own company rather than use the present security company and build up your credibility and services."
The father could see the prospects. Whether he would be able to execute my idea, that is the million-dollar question. "It is more than 50% of the problems solved," I replied when he said that he already got the source of dog training school and the good relationship with the people there. "Very few if any Singaporean or Malaysian has this type of contact."  Retirees in security business for many years have a large number of contacts if they know how to network with them to start a new business.
      

1198. A mother's sacrifice

Nov 30, 2012 was the last day of work for Dr Vanessa. I wished her well in her new venture as I had expected that she would be her own boss. She gave me a piece of chocolate cake to celebrate her birthday.

I had promised to send a Jack Russell with skin disease home at Lorong 8 Toa Payoh after treatment and clipping for skin itchiness. The domestic worker would wait at the first floor of the HDB block to take over the dog. I asked my intern (a young man in junior college year one) to put the dog in a crate. Min helped him. The owner had to go overseas and so I volunteered to send the dog back after grooming and bathing for the skin disease.

"It is the wrong dog," Dr Daniel phoned me. "There are 3 Jack Russells in the crates and you have got the one with the bladder stone."
Just a few days ago, the Kandang Kerbau Hospital had given the wrong babies to two mothers. One of the ankle name tags had fallen off and so the baby was given to the wrong mother. One of the two mothers discovered the mistake and there was needless worries and DNA checks.  The private hospitals use RFID tags and so had no problem.   

I may need to use RFID tags to identify the dogs but this would not be necessary as I don't have more than 10 dogs. Somehow, Min had given me the wrong dog. I asked the domestic worker to get permission from her employer to go back with me in the car to get the dog as the dog would bite. She got the permission via her phone and we went back to the Surgery to get the dogs.

"How long have you worked for the same employer?" I asked her.
"Twelve years," she surprised me as most workers don't stay more than 2 years.
"My employer is good," she said. "The dog is obedient too as he does not lick my face. He would look the other way. My religion does not permit me to touch dog saliva."     
She walked the dog but does not feed him medication.
"Why do you work so many years?" I asked.
"To earn money for my children's education. My daughter is now grown up and is married. She will never be working as a maid like me."
Many maids made great sacrifices being away from families and going home 4 weeks every two years.so that the progeny can have a much better life.
 
  

1197. Three teeth in a one-year-old dwarf hamster

Saturday Dec 1, 2012

The hamster with the swollen upper nose came back as she could not gnaw seeds. 4 days ago, Dr Daniel had incised the upper right area of the nose, draining the pus. Now, the lower right area of the nose below the right nostril had become more swollen. "The right nostril is bigger in diameter than the left," I said as the gentleman owner had complained that the hamster had sniffling sounds.

The hamster's upper right area was slightly swollen after drainage of the abscess. It took one month for the abscess to ripen and it was lanced 4 days ago on Nov 27, 2012. The lower right upper area had shown on pimple but was mainly hard as a rock. So, there was no point cutting it as it was not "ripe" meaning that the abscess had not come to a head.

The hamster squeaked when I tried to open the mouth with forceps but othewise was "sleepy" when hand-held by the girlfriend for me to take images of the inflamed area to document the condition. There would be another 4 days before this area would ripen and pus could be released. I scheduled Dec 4, 2012 to operate.

This hamster has only 3 teeth instead of 4. One right upper incisor and two lower incisor teeth with a gap between them.
"Was he born with 3 teeth?" I asked the gentlema as the hamster's front teeth grow continuously unlike human teeth. So a fractured one would grow back and the hamster wears out the teeth by gnawing and eating seeds..
"He had four teeth," he said.
"You dropped him when he was young," the girlfriend said.
Presently the hamster gained 5 g, from 40 g some 4 days ago after lancing the abscess. He would eat the bananna paste and loved the green jelly but could not chew on seeds or pellets for the past 4 days. So that was why the couple consulted me.
"He used to be 60 g," the man said.
"Once the abscess in the lower right area of the right nostril is soft and lanced, he will put on weight, befitting his name of "Ah Pui" (Fatty in the Hokkien dialect).

1196. Spaying a dog at "6 months" of age

Saturday Dec 1, 2012

A young couple had made an appointment with me to examine their 6-month-old female dog before spaying next week. "Dr Vanessa has resigned from Toa Payoh Vets and her last day was yesterday," I said. "If you would like Dr Vanessa to spay your dog, you can contact her." Clients can have their personal preferences of the 4 vets at Toa Payoh Vets. Since it was Ok with them, I proceeded to examine the dog whose body was that of a cross between a Westie and a poodle. At 4-kg, whe could be considered suitable for spaying.

I opened the dog's mouth. Her temporary canine teeth were all white and narrow while her incisors were white and broad. "Your dog is less than 6 months of age," I said. "The permanent fangs or canine teeth will erupt at 5-6 months of age, pushing away the 4 puppy canine teeth. However, they have not yet erupted."

The couple was surprised as they were told by the sellers at Pasir Ris that the puppy - a MalteseXpoodle was 3 months old and that was 3 months ago.

"The likely explanation is that the AVA (regulatory authority) permits sale of puppies at 3 months of age. But younger puppies are more in demand and fetch a higher price. So, the puppy was sold at around 2 months of age." The vaccination certificate was not available.  In any case, this puppy was less than 6 months of age.

"Can the dog be spayed at 5 months of age?" the lady asked.
"Yes," I said. "The animal welfare people sterilise them as young as 4 ,months of age. My advice is to spay her 2 months after her first heat to permit her private parts to develop fully to a msture state. But if you want to spay her before her first bleeding, 6 months of age would do." I showed the couple that this dog still had not develop the nipples. It would take time for her to mature.

"The vulval area is brownish," I said. "Is she licking her privte part? If she does, she may have a urinary tract infection."

I gave the couple a urinary bottle to collect urine for urine analysis as I could palpate a half-full bladder.  "Clean the pee pan well and flush with water. When the dog pees there, collect 3 ml of the urine with this sterile syringe."  The couple went home and came back soon with a bottle of yellow urine for analysis of bacteria.

"The last time she was checked by Dr Vanessa, the urine dipstick showed protein present," the young man said to me.

"A urine sample for analysis would be necessary to check for crystals, blood cells and bacteria."

Young vets must know when the permanent canine tooth erupts so as to estimate the age of young dogs. They erupt between 5-6 months, not 6-8 months, generally. In this way, they can estimate the age of the young dog.

 
   

 
  

1195. British bulldog's cauliflower stone surgery

Nov 27, 2012
Yesterday morning, I mentored a bladder stone surgery on the female British bulldog, 4 years old. The dog is OK today.

Eats like a horse, the owner said. Home-cooked food and dry food. Yet, a big stone. The dog was on antibiotics and S/D diet for a week.  "Can you guarantee the stone will dissolve by S/D diet?" the owner was tired of having to clean up the dribbling urine every few seconds. "My dog passes greyish urine yesterday, like ash." I said I doubt it. "So, it is better to operate. She has lost a lot of weight. Much lighter now."

I required a blood test and urine analysis on the day of surgery. This had been done before, my associate said. "It is best to monitor the latest situation."

SURGERY
Dr Daniel operated. I assisted.
I got syringe of urine direct from the bladder for urine analysis. Dark red brown urine.
Incision from apex of bladder 1.5 cm.
Thick bladder wall of 5 mm. Bloody.
Suturing. Continuous on mucosa, then 2 layers of inverting. 1 layer could be OK but I advised two layers.

BLOOD TEST RESULTS -Nov 26, 2012 on day of surgery
Total WCC 11.5 (6-19). N=89%, L=10%, M=1%, E=0, B=0
RBC and platelets normal. Urea and creatiine below normal.

URINE ANALYSIS- Nov 26, 2012 direct from the bladder
Red turbid, pH 8.0, SG 1.019, Protein 3+, Blood 4+, WBC >2250, RBC >2250
Crystals Triple phosphate occasioal, bacteria 3+
I did not request an antibiotic sensisitivity test to reduce costs.

1194. Follow up. The Schnauzer vomits again - bladder stones & kidney stones

Thur Nov 22, 2012


Vomited one month ago. Had kidney and bladder stones. I removed bladder stones, analysed as struvites. No vomiting for past month. On last Sat, came in as dog vomited. Warded. Vomited several hours after eating. Why?

Blood-borne infection. Urine has bacteria. Amorphous urate 2+. What's the cause and the solution?

X-rays today.

Spoke to a vet more senior than me. He said that very rarely did he encounter kidney stones. He had operated on one. "Very painful for the dog, need to give pain-killers post-op".

"Kidney stones occur in 4% of urinary stone cases, according to one Australian specialist vet presenting the SVA 2012 seminar," I said. "This vet said that if the incision of the kidney to remove the stone is more than 50% of the kidney length, the kidney would not function normally."

The X-ray showed the kidney stones to be more distinct. The dog had been on canned S/D diet for the past month and no other food. A lot of gas in the intestines. No stones in the bladder on V/D view. Is there any stone inside the ureter? This could partially obstruct the ureter and cause pain, nausea and vomiting hours after eating. The dog still eats and appears active. IV drips and antibiotics for the past 2 days. Wait and see.

Urine analysis revealed amorphous urates 2+ in urine pH 6.0, USG 1.017, blood 3+, bacteria 2+

Were the kidney stones of the left kidney URATES instead of struvites? It is hard to tell. Very rare cases of kidney stones seen by me for the past 40 years of practice.


UPDATES & MORE IMAGES AT WEBPAGE:

http://www.sinpets.com/F5/20121108vomiting_kidney_bladder_struvites_schnauzer_toapayohvets.htm

1193. Pus in the left eye - dwarf hamster

5759. Pus in an eye for the past 2 weeks

5760. No pus in an eye after 20 days of treatment

5761. No pus in an eye after 20 days of treatment

5762. Overview

Pus oozed out from the swollen conjunctiva. The whole left eye was badly infected. How to resolve this problem? Cutting up the abscess would be a calculated risk as the hamster might get blinded. Conservative treatment with eye drops and nursing needed 23 days. The hamster went home to a delighted little girl.

Webpage at:
http://www.sinpets.com/F6/20121123hamster_purulent_conjunctivitis_toapayohvets.htm

1192. Email query on tick control collar

On Wed, Nov 21, 2012 at 3:35 PM, Nicky @gmail.com> wrote:



Hi,



I have a golden retriever who is 4 years old and weighs 23kg. He is infested by ticks currently and is using the product "certifect". I would like to ask if I can use both the "Preventick Tick Collar" and "Certifect" together or do i have to use the 2 products separately?



Thank you very much.



Best regards,

----------------------------------------------

I am Dr Sing from Toa Payoh Vets. Certifect can be used separately. I have no knowledge of what "Preventtick Tick Collar" is as I don't use it.

1191. Guinea pig from Chua Chu Kang made resp.noises for the past 5 days

Wed Nov 21, 2012

At 7.30 pm, by appointment, the mother and two adult daughters brought the guinea pig, female, 4 years to consult me. "She makes noises like an engine for the past 5 days," the daughter said. "Now, she would not eat the pellets but just the vegetables. She would lie on the litter and not be moving. Liked to bite her lower part."

I checked the heart and lungs. Normal. No nasal or ocular discharge. Large ovoid shaped pellets passed. The coat was badly matted.  The "noises" could be an upper respiratory infection or pain as the guinea pig tries to "de-matt" her clumps of coat in her back half.

I recommended Agnes who does guinea pig grooming. "How much?" the daughters asked.
Agnes said: "$40.00" but she was not free till the weekend. She explained to me she had to take care of her children. It is school holidays and she had some programmes. She had to fit in work-life balance with a brood of five children.

As for the guinea pig, the mother said she would come on Friday as she would be working. I said I would be in Malacca on a "Peranakan heritage tour" and so the older daughter said she would bring in the guinea pig on Thursday morning. She would wait while my assistant would clip off the coat and de-matt the hair.

The family had shifted from Ang Mo Kio to Chua Choa Kang in West Singapore and had taken so much trouble to come to consult me. Veterinary medicine is a very personalised service for many pet owners. The vet must stay the course for years as many younger vets come and go or work in various clinics and so could not be available.    

1190. Follow up on Schnauzer with kidney & bladder stones

Wed Nov 21, 2012

The Schnauzer came back on Saturday as she had been vomiting the past 2 days. Blood tests revealed a high white cell count and urine test showed amorphous urates 2+ , blood, and white cells. The dog was on IV drip and antibiotics on day 1. She did not vomit. Ate food and vomited again yesterday.

It is possible that the kidney stones had caused this urinary tract infection. What is the solution? Cut out the stones from the kidney? Presently, a lot of pain in the abdomen. Bacterial infection is treated first and let the dog stabilise. X-rays will be needed.

1189. The Schnauzer scratches all over his body. Why?

Wednesday, November 21, 2012


1189. The Schnauzer scratches all over his body. Why?



Skin diseases are most common in practice. There are many causes and one of them is a lack of grooming as Singapore pet owners are harassed by the fast-paced city life.



In this 7-year-old male Miniature Schnauzer, his whole body, limbs and backside are itchy. The Schnauzer had a good coat until recently. He had not been to the groomer for some time. "My wife used to take care of him," the man in his late 40s told me that the dog had a good coat previously. The wife was no longer around and the dog developed generalised itchiness in the body, limbs, backside and ears. Hair loss over parts of the backside and legs.



A urinary tract infection was evident from the presence of blood and bacteria. The X-ray did not show any radio-dense stones. "There could be prostatitis," Dr Daniel discussed the case with me and had spoken to the owner about neutering. "Spermatozoa +++" was present in the urine analysis. This lab finding does occur and my hypothesis is that the male dog displayed hypersexuality. Neutering would certainly resolve his behavioral problem.



I noted that the prepuce was inflamed. It was possible that this male dog had relieved his pain from an inflamed or enlarged prostate. For some male dogs, neutering would prevent much prostate problems of inflammation and infection at the older age.



The dog has an excellent appetite as you can see lots of the dry dog food in the stomach and intestines.




A follow-up one month later would be advised.

1188. Sunday's interesting case - the cat with the balding backsides

Sunday Nov 18, 2012  Bright sunshine in the morning. Heavy downpour in the afternoon.

Case 1. Four months ago, this old male neutered cat was losing hair on both backsides. Balding patches. So I was rather surprised to see him with a full bloom of coat - freckled and thick. The Indian father and his adult graduate daughter came early in the morning to get some matted hair below the armpits removed. A complaint of itchy ears.

"He is such a nice cat," Dr Daniel commented. "He did not claw or scratch when his ears are cleaned."

"He is very timid when at the vet," the father said. "At home, he is a lion."

I really admired the thick coat and asked what happened. Many years the cat had baldness in the inguinal area and the coat was in a mess. I discovered it was the management of the litter box. The cat had dirtied himself when he went in and came out of the litter box which was lined with newspapers. What is the secret of his full coat? I reviewed my medical record of 4 months ago. The cat's anal sacs were infected and expressed and medication was given. An antifungal wash.

"Now we have 2 litter boxes," the father said. I can't remember whether it was my idea or not as I do not record every advice I gave and neither did I claim credit. "The cat would go into one to pee and one to poop. He would not go into any of the two till we clean it." So, that was the secret to such a lovely coat for this 8-year-old cat. 

It was great to see this old cat having such a beautiful coat nowadays, considering that the father and daughter had so much worries over his balding backsides.

Case 2
A "gigantic" dog bigger than the Siberian Husky and more to the size of an Alaskan Malamute visited the clinic. His size was enough to send any lady or man into shivers. Like a big white wolf. He sniffed the door 

1187. The cat foster lady

"Sometimes, it is not the money but the shortage of time," I said to my associate vet who had amputated the kitten's left forelimb and had hospitalised it for 3 weeks. The wound did not heal well and the cat foster lady could not nurse the wound at home. So it was hospitalised here for some time.   

2 evenings ago, the foster lady came to visit the cat after being absent for 3 days due to her workload. My associate vet had gone to visit the ailing grandma on that Friday evening and so I spent some minutes talking  her. "Should the bandage be changed?" she asked me. "No need to change everyday," I said. The wound is healing by granulation. She usually spent time with the kitten till she had to go home. This time, the kitten peed onto her pink T-shirt. She went to the bathroom and changed to a floral one.

Today, Monday, Nov 19, 2012, the lady came. She was overjoyed when my associate vet released the cat to go home.

More Singaporeans are being kinder to stray cats and dogs now than 10 years ago. What happened to this stray kitten was that her left forelimb was paralysed. Her left eye cornea was 90% opaque and her right eye cornea had two large spherical bulges. 

1186. Haematuria in a British bulldog. Durian seed, bladder stone or a botched up spay?

"Could it be a durian seed? My dog rushed and swallowed one yesterday, before I could stop her," the be-spectacled woman in her late 40s was not fully convinced that the X-ray showed a big bladder stone in the ventral dorsal view was really a bladder stone. Her 4-year-old spayed female British bulldog had peed blood in the urine for the past 2 days.

"There is a lot of food in the stomach and intestines," I said. "It is hard to see the durian seed. Definitely, the stone is a large bladder stone. Have you been feeding dry dog food for the past 4 years?"

"No, I stopped after she was over one year old because the other vet advised me to feed home-cooked food to resolve the skin disease problem. I only gave her the dry food in the last 2 days when she passed blood in the urine. Could it be a botched spay operation done by Vet 1 when she was one year old? When she passed urine, I could see the blood in the urine."

"If the spay had not been well done, the dog would be passing blood without any urine every 6-monthly. The blood would not just be present together with the urination." I said.

"I do not see such occurrences," she said. "How about the durian seed? I forgot to tell Dr Daniel about it earlier."

"There may be a durian seed but it is not seen in the X-ray," I said. "The big mass is the bladder stone in the bladder."

I advised antibiotics for 3 days before surgery. The owner brought her trolley and dumped her Bulldog upright inside it and took her home today. The urine analysis and blood test results are pending. 

1185. Audit Review of skin disease: The black Mini Schnauzer still bites her legs again

Sunday Nov 18, 2012  9.58 am

Skin diseases are due to many causes and each vet has his or her own way of diagnosis and treatment. Some cases need regular reviews monthly but rarely do owners bother to do it. Some cases get cured with one or two treatments. In the following audit case, I review the case treated by my associate vet in more detail as the owner came back again some 3 months later after the first treatment at Toa Payoh Vets on Nov 15, 2012 and as she spoke in Hokkien, I took over the case from the associate vet who could not speak a word of this dialect.

I was present on Nov 15 and saw her male friend shaking his head disapprovingly. "Your husband is shaking his head," I said. "He is a friend. I am a divorcee," she informed me. So, one must not presume spouses anytime. I asked for her history from the previous vet. There were 13 pages of record.

Today Sunday, I phoned the owner at 9.50 am. Nobody answered. Too early for a Sunday morning or she had gone out. Over 50 years old lady.


Mini Sch black, female, spayed

Social media and google docs. Can old dogs learn new tricks?

Nov 17, 2012
To: Young new graduates - marketing your expertise in the social media is hard work
From: Dr Sing Kong Yuen

Use google docs and social media to promote your expertise

The golden age of the internet is here. Yet, most young people don't know how to use the social media to promote their skills for prospective cients.

Gaming is fun and pleasure but will not create awareness of your hobbies, skills and expertise as a vet or hobbyists.

Facebook with pictures of fun and beer drinking and outrageous behaviour of the young undergraduates at school will make the their baby-boomer mothers blush, but actually such images cast the young persons involved as being lacking in self-discipline and morals and demonstrate irresponsibility to hold top management positions to prospective employers.

Use google docs to get your financial statements stored, rather than emailing attachments to the employer. The employer just click on the link with a password. This is what I mean by using social media to be more efficient, productive and smart in your profession.

With the new Samsung Notebook Lte, it is possible to write directly onto the phone-tablet. I can see this as a new way to record case studies by writing instead of typing on the keyboard and then storing the record in the cloud. Typing during consultation takes a lot of time and so this Samsung Notebook with pen will be an advance in medical recording, if you know how to apply the tools of the trade.

Read, research and apply the tools of social media to promote your expertise. It will be dull and boring compared to thumbing text messages to your friends and they thumb back trivial news to you, back and forth during your working hours. It is hard work and requires daily input on the blog, facebook or other social media. Few young ones will do it. So, this is where you distinguish yourself as a professional or hobbyists. Rarely do baby-boomer generation people do it but then they are set in their ways watching TVS or online movies and have no time to learn and apply new technologies to promote their expertise. Well, they are either established in their management positions or about to retire. Why would old dogs learn new tricks?

It is time to change your mindset if you want to distinguish yourself in this extremely competitive world where prospective clients are much more sophisticated and demanding of the highest standard of service at the lowest costs by surfing the internet.

1183. Visual arts - artist

I rarely encounter artists as clients.
One of my clients is a visual artist.
Website
 http://tfcsea.nafa.edu.sg/artist_biography.aspx?id=35

Her father's website

http://tfcsea.nafa.edu.sg/artist_biography.aspx?id=14

Many times, I can't figure out how an artist can earn a living as their art pieces need promotion, marketing, affordable pricing.  Many don't seem to like to draw Singapore River scenes or local cultures as I presume there is no demand.

In some art exhibitions locally at the malls, some of such local scenes are good pieces of art but the prices are over $1,000.

It is time for the new artist to start their own website and display their artwork and pricing. But most don't do it and so the average man can see their artwork and can't buy their art pieces without having to go through an art gallery!  

Lately Singapore has an "Affordable Art Fair". 

Should young practising vets display their "artwork" which would be case studies with photos of before and after so that the prospective clients know what they are skilled at? Well, most don't do it. It is just too much time needed to do it!

1182. Intense scratching of face and neck - poodle case review

Nov 16, 2011

I was reviewing a skin disease case and phoned the retired pharmacist.
"My poodle is OK now. 95% cured. Nibbles at front paws and will stop when I scold him."
"You can't be monitoring him 24 hours," I said. "Did you eat the Z/D diet?"
"He didn't like it, so I mix it with the usual dry dog food,"


Some info

Poodle, M, 4 years, landed property
Fed various brands of dry dog food

May 5, 2012
Itchy face, neck, paws, elbows. Skin scraping - no mites. No ringworm. Ears normal.
Medication and an anti-mite insecticide wash.
No further complaint.

Oct 20, 2012
Went to emergency night clinic.
Uncontrollable scratching of lower night all night until it bleeds.
Blood test normal. Skin scraping fungus and bacteria, no mites.
Hyperpigmented skin on ventral neck and dorsal surface of front paws - suggestive of chronic skin disease. Advised skin allergery/atopy workup.

Oct 21, 2012
Treated for bacteria and fungus. Canine Z/D trial for 3 months accepted by owner.
But the dog did not like it. So he did not give 100% when I phoned him on Nov 16, 2012 (today). He said the dog is 95% Ok with hair growth back to the areas. Except for front paws licking occasionally.

This case illustrated the great difficulty of some owners to do the Z/D food allergy elimination trial. "The dog is OK in the past 4 weeks," I said. "This is due to the medication. The real test will be the next 4 months. If you don't try the ZD, the dry dog food allergy may return once the drugs wear off."

Skin diseases are costly to treat but many owners don't realise the importance of review 4 weekly or the use of Z/D or equivalent food trials. The vet may need to keep a record and call the owner but we seldom do as we don't even have time to sit down.



Oct 21, 2012
Case came to me.

1181. Urine collection from guinea pigs for the vet - blood in the urine

PROCEDURES FROM TOA PAYOH VETS
BLOOD IN THE URINE

URINE COLLECTION BY THE OWNER/VET

1. Put guinea pig in a clean plastic box without chemicals. Syringe him or her 10 ml of water slowly.
2. Tilt the box slightly so urine will flow away from the faecal pellets.
3. Use a sterile syringe to collect the urine and give it to the vet. At least 0.5 ml of the urine or up to 5 ml.




URINE ANALYSIS
Urine dipstick test for blood etc.
Urine analysis by the lab
Urine cultures


X-RAY
5. X-ray of the bladder by the vet advised
Urinary sediments - amorphous urates (acidic urine) or amorphous phosphates (alkaline urine). In this case, urine analysis detected amorphous phosphates ++, the pH was 9.0 and bacteria was present in the urine.


CLINICAL SIGNS TO CO-RELATE WITH LAB FINDINGS
Loss of appetite
Difficulty in urination
Blood in the urine - red urine due to plant pigments or blood due to infection/trauma or urinary tract
Drinks a lot or little

ADVICES
It is difficult to use diet to acidify the urine. I advised a course of antibitoics,  cutting down on too much wheat grass and hay and more water to drink as well as pesticide-free vegetables.Will need to follow up on another urine analysis.  As at Nov 19, 2012, no complaint of haematuria.

1180. Second operation of the hamster with the right fore paw tumour

This morning, the young man came at 9.44 am to get his hamster operated. I was surprised that the hamster's cheek pouches were bulging with food and he looked much more alive than yesterday (Tuesday Nov 13, 2012 - a public holiday, Deepavali)

The young man had brought the dehydrated and easily tired hamster for surgery. "I had told your mum to quickly bring the hamster to me when the lump regrows," I had sliced off the large tumour on Oct 3, 2012, sparing the hand. "The hamster can hold and grip food after the surgery," the young man said. "But only last week, this growth started and became very big." It was a reddish globe of 8 mm x 8 m. It made the hamster look as if he was wearing a boxing glove. He was much irritated by it as it was painful and inflamed.

I prescribed oral antibiotics and pred yesterday 

1181. Skin diseases in two adult Westies

Case 1.
"You are so rough," the lady admonished me as I flexed and extended, abducted and adducted  the Westie's left shoulder and other joints of the left fore limb. She expected gentle manipulation.
"If the joints are normal, a vigorous manipulation would not cause any pain," I replied. "See, only the dog was crying when I extended the left fore paw, but had no reaction on the shoulder, elbow joints. Gentle manipulation may not show any problems in the joints."

Today is Saturday Nov 10, 2012. I was at the Surgery at 8.45 am. Phone calls came in at 9 am for appointments for Dr Vanessa and one for Dr Daniel but both were not working today. I caught up with my admin work, checking on associate vets'  cases, data mining, reviewing past medical records and doing a thousand and one things.

Suddenly a lady brought in her 7-year-old male Westie saying the dog had been limping. The dog could put weight on the left fore limb but occasionally lifted it up quite high as I observed him in the waiting room. He wouldl not walk into the consultation room where the lady called. So I came out and opened the door. Slowly he went in.

"The dog's backside is itchy," the lady in her late 30s said. "I sent him to the groomer recently."
"The dog's anal area is black and brown," I expressed the anal sacs and blood with dark brown oil were seen on the tissue paper applied to

"Has your Westie any more infection of the ears and the skin?" I checked the medical records. The Westie was a referral from her friend who was 16 years old when I treated the case and was now 35 years old, according to this lady. So, 19 years had passed for this young girl whose identity I do not know.
Westies are famous for skin diseases and so I reviewed this case of success for my knowledge.   The owner did follow up reviews and the disease was cured

10.33 am Another client with a Pom comes in.

1178. Gum ulcer in the 15-year-old cat

Taught the owner how to "inject" feed pellets into the old cat. She had a gum ulcer and so did not eat. The owner did not know how to use the syringe or pill popper and so the pellets fall out from the mouth. 
Why did the old cat stop eating? Is it because she's 15 years old. At the end of the life span? Vet 1 had been consulted and gave some medication.

"My cat attempts to grip the food, but gave up."
So there would be some problems with the mouth. I opened the mouth. A big swollen lump appears at the gum/tooth junction of the left upper canine. This was extracted. The cat still would not eat. The owner had to syringe feed 3 to 4 times a day again.

I examined the case a few days later. There was an ulcer caused by the long sharp left lower canine, causing a red oval ulcer in the opposing upper area where the canine teeth had been extracted. The periodontal abscess of the left upper canine gum area had shrunk. This was good news.

left lower canine was extracted. A big tumour was seen growing on the spinal area. "This looked like a nasty fast-growing tumour. It is best to send to the lab for testing," I said. The big tumour was excised and the lab results showed a poor differentiated carcinoma.

Yet the cat would not eat and the owner had to go on a business trip. He said to me, "My cat does not have cancer as the test did not show cancer. Yet she is not eating. Do you have any medicine to make her eat?" I asked Dr Daniel if he had said that but he did not say that. A carcinoma of the skin is cancerous.

The cat still had that upper gum ulcer. But the main problem was that he did not use the syringe popper properly. He did not insert it far back to the back of the mouth. So the dry pellet just landed in front of the mouth and the cat just pushed it out. Dr Daniel and Min showed him how to do it. We put the cat on the table, one person opened the mouth and the other popped 5 dry food pellets into the mouth via the popper. The cat swallowed.

Nov 13, 2012 update. The owner said that the cat was eating a bit and was interested in food after Dr Daniel prescribed some tolfedine painkillers.

Later,

1177. Follow up on Ascites in the Pom

Today Friday Nov 9, 2012.

I reviewed the case handled by Dr Vanessa. She had aspirated some at 1 bdominal fluid yesterday and again today and the abdomen was not so tense. The dog ate a little.

"There appeared to be a large abdominnal tumour," I believed it could be a malignant metastasis from the breast tumours excised by Vet 1 earlier. In any case, the dog had a very high total white cell count, indicating a blood spreading bacterial infection. The dog was sent home with medication and given a poor prognosis.

"The tumour may be inoperable," I advised no surgery as the dog was in very poor health and would likely die on the operating table. No dog owner would forget the death as it would be emotional and costly. Therefore, I asked for the dog to be sent home today for observation. The cause of the ascites could be the heart disease.

Further X-rays and tests are needed but this would be too costly. The vet must understand the cost and the chances of survival before undertaking surgery. Inoperable tumours and poor health and heart disease are best not operated.   

In conclusion, I wonder whether it would have been kinder for the female dog if she had been spayed at a young age as breast tumours are less likely to develop during her senior years. Vet 1 did not send the tumours for histopathology based on economic reasons.  

1176. Three-year-old cat vomits and can't poop

X-rays show hair balls. Kitchen floor tile renovation recently. Cat grooms excessively and may have got hair ball obstruction. X-rays show the hair balls. Likes to play with ribbons too.

Laxative and enema 2 times - stools come out.

1175. Hard swollen abdomen in an old Pom - Ascites

X-ray of a hard swollen abdomen present for the past 4 weeks.
Dog was spayed in July 2012 by Vet 1. Inguinal hernia repaired and mammary tumours were excised by him.
The old Pom still had a hard swollen abdomen.

Owner said the 9-year-old dog was coughing a lot after operation and passed a lot of urine but was otherwise normal. 
Aspirated >200 ml of blood-tinged yellow gelatinous fluid from abdomen.

Vet 1 gave a better medical history than the owner. Ascites was confirmed by aspiration. X-ray showed radio-dense lump like a big abdominal tumour. Aspiration is important. There may still be a big tumour. Liver tumour? But liver enzymes are normal. 

1174. 15-year-old cat not eating

This 15-year-old cat would greet the owner when he comes home. Meow. She used to grumble a lot on the way home, inside the car, when she was being taken home from the boarding cattery during her younger days in Australia.

For the past month, she just would not eat. Syringe feeding 3x/day on A/D. Seen Vet 1. Saw me. Still would not eat.

Insulinoma? Hypoglycaemia in a female Miniature Schnauzer

"The 5-year-old spayed Miniature Schnauzer has 3 problems," the lady owner told me as I noted the lumps and scabs crusting the upper surface of the spinal area. "Skin infections in this backbone area, ear infections and urinary tract infections."
The dog had been to Vet 1 who had diagnosed UTI and had found one calcium oxalate crystal. He advised ultrasound at another practice and the report dated Sep 3, 2012 stated that the liver was enlarged, gall bladder had sediments 20%, stomach distended, intestines thick-walled, bladder had echogenic materials, kidneys inflamed.

I palpated and got a slight pain from anterior abdomen which appeared swollen. Onset of recurring UTI started a few months ago, vulval licking around one year ago. Anal sac expressed - thick oil +++
No steroid inj as the owner was not in favour of it and Vet 1 had already injected on Jun 29, 2012 for the "hot spots on dorsal back region" which was what had happened again in this consultation.

URINE TEST
dipstick pH 6.0, SG 1.040, Pn 3+, no blood, no white cells.

Commercial Lab Test -   pH 7.0, SG 1.048, Pn +, no blood,  white cells present, bacteria +, nitrites +,
ketones trace, crystals nil

BLOOD TESTS RESULTS MORE INTERESTING
1. Total cholesterol 11.28, HDL 5.7, LDL not able to estimated due to interference from elevated triglycerides level of 14.30

2. Glucose 1.4  (3.9 - 6.0).   Hb 20.9 (12-18) but other values are normal. Kidney and liver are normal.

So, what is the main problem? UTI.
What's the solution?
Nov 7, 2012 7.30 pm I phoned the owner. On Nov 5, 2012, Dr Daniel had used his GPS and drove me to the Bishan apartment. I delivered the blood test and urine test results in her post-box as Dr Daniel was going to Bishan. Today, I asked her. She did not go to the letter box yet.

Q1. How's the right ear?
Scaly. No pus.

Q2. Urine.
A. No blood. No dribbling or incontinent.

Q3. Does the dog drink a lot?
A. Drinks little. This explains why the UTI recurs. There is insufficient urine production to flush off the bladder's sediments which I presumed included calcium oxalate from the dry dog food. This explained the high USG of over  1.040

Q4. Still feeding the dry dog food? The owner bought expensive organic dry dog food of different brands.
A. Yes.


VET 1'S  CASE REPORT
1. June 29, 2012   Hotspots on dorsal back region. Antibiotic and shincort injection.
2. Jul 30, 2012      Haematuria & dysuria. No stones palpated inbladder. Cystitis. Advised to review with urine analysis and ultrasound if recur

3. Aug 18, 2012   Vaccination
4. Aug 28, 2012  Haematuria. Appointment for ultrasound at another practice.
5. Sep 3, 2012     Owner showed ultrasound report indicating "cystitis" and renal inflammatory condition". No stones, mass, polyps in ultrasound. Urine analysis - leucocytosis, glucose -ve, blood -ve, one calcium oxalate crystal seen.
6. Sep 25, 2012. Otitis externa right ear. pus.

This case is a challenging case and the whole history and situation has to be reviewed regularly. The main problem is the recurring UTI. According to the owner, onset of dysuria, haematuria, polyuria started a few months ago. The vulval licking was around one year.

How to solve this problem economically?
I SPOKE TO THE OWNER AT 7.30 PM AND THE FOLLOWING PLAN OF ACTION
1. Increase water intake. The dog drinks little. Therefore canned food. No dry food. What brand?
2. As one calcium oxalate crystal was found by Vet 1 and the pH was NOT stated in his two urine test on Jul 30 and Sep 3, 2012, it is hard to know whether the urine was alkaline or acidic.
Based on my urine test on Nov 3, it was pH 7.0 (neutral) but bacteria was present. No urinary crystals. Why was there positive nitrite?
3. For the next 4 weeks, strictly on U/D diet and re-check the urine again for infection. If no recurring UTI, the dog should be on U/D diet for some months.



Low glucose. The dog did not faint or go into fits any time as the owner did not complain about this. So the low glucose on Nov 3, 2012 was a puzzle. The beginning of insulinoma since ketones (trace) was present in the urine? High lipid in the blood - gluconeogenesis, starting ketosis?

More reviews will be needed.

 
















 

2 weeks after spay - the aggressive cat from Hougang

I have removed her e-collar on Monday. I noticed that she keeps trying to pull out the surgical sutures (which is still very intact) and I'm afraid that it might "tear" her skin or something. Hence, may I know if I need to come back to your clinic to remove the sutures? or will it fall off on its own one day? Should I let her continue to lick her incision site so that the sutures will fall off faster?

.Hope to hear from you soon!

p/s: Thank you for the follow-up call to check on my cat's well being after her enema treatment on the eve of Hari Raya Haji. Great service! =)


Regards,
Di
Mobile:
-------------------------------------------------------

EMAIL REPLY FROM DR SING DATED NOV 7, 2011
On Wed, Nov 7, 2012 at 6:31 PM, Kong Yuen Sing <99pups@gmail.com> wrote:

If you have time, best to come and get stitches removed. If no time, put back e-collar and stitches will dissolve in Day 21-30 after surgery or earlier. If you have courage, get a pair of small clean scissors and cut at the knot

PHONE CALL
Phoned owner Nov 7, 2012 6.31 pm
1. She can take out the stitch but will email image of wound area before doing anything.
2. Cat had constipation post op and difficulty taking medication.
3. Cat would eat on day of surgery

1170. Eosinophilia in a Chow Chow from tick bites?

Only the best for this client and his Chow Chow was his pride and joy. Last week, his man brought the dog to me. This Chow Chow had lost a lot of hair, around 80%, with some left in the head and tail. His bare skin was black. A bigger version of the hairless Chinese Crested dog. Lumps could be seen all over the bare skin. "Get your groomer to clip off all the hair," I advised. No news from him till 4 days later.

"The Chow Chow has lost appetite and is very itchy," the man in his 40s said. "He had lots of tck bites. We applied Revolution 2 weeks ago and Frontline 3 weeks ago."

The Chow Chow had two bleeding spots at the tips of both ears. I asked Dr Daniel to check for scabies mites by taking a skin scraping of the areas. "There is a tick seen under the microscope but no scabies," he aske me to view the slide. True enough. One newly hatched baby tick.

"It is best to do a complete blood test," I advised. "To check whether the liver and kidneys are affected as well as the overall blood cells."

"Let me phone Mr Tan first," he said. Permission was given.

CHOW CHOW, M, 3 years, 21.3kg, 39.3C

Blood test results
The following was low   Urea 4.0 (4.2-6.3); Creatinine 81 (89-177).

Total WCC was normal, but N 66%, L 12%, M 1.4%, Eosinophils 21%, B 0%
Absolute                                N 10.08, L  1.75,  M 0.21  Eosinophils 3.15    B 0.0
PCV and platelets normal

Could the tick infestations cause eosinophilia?
Yes. Parasites can cause eosinophilia. So can allergy and some infections.

This is one case where eosinophilia is caused by tick bite allergy.

On Nov 6, 2012, the next day after treatment of the dog, I phoned the man.
"The Chow Chow now eats his usual two meals a day," he said.
"Is he still scratching his body?" I asked. The anal sacs were also filled with thick greyish oil and could cause itchiness of the back and tail biting.
"A bit of itchiness, here and there," he was quite pleased with the response.

I was glad that this Chow Chow did not suffer from tick bite fever or anaemia. Surprisingly, the two Golden Retrievers living in the same area had not one tick. So, could the other dogs be immune to ticks or the Revolution and Frontline were working fine? It is a mystery.


PHONE CALL TO THE BUSY OWNER to understand what's going on.
Lately the entrepreneur is busy with interior designing business for new apartment owners.
"Did you propose a fish tank?" I asked.
"The units are so small nowadays," he said. "It is hard to place the usual cabinets, sofa sets and carpets."
He told me one expatriate sold off his 3-bedroom condo for S$2million and bought a villa with 6 bedrooms and a pool in Johor Bahru for S$1 million and has left over money.
  
Q1.  Was the Chow Chow's skin so black since young?
A.     No. Only since Mar 2012. The skin was pinkish.

Q2.  Your brother said that the two Golden Retrievers have no ticks at all.
A.   Not true. They have ticks and so have the other 7 dogs but this was not a big issue. The source was from the 19-year-old Cocker Spaniel who was allowed into the open field brought in the ticks. The other dogs were housed indoors as there is a big terrace for them.

Q3. Was there any ointment or medication applied to the Chow Chow's skin?
 A.  No. Coal tar shampoo was used for all dogs last year though.

Q4. When did the Chow Chow start losing hair?
A.   In March 2012. He started biting his tail and the hair loss from the tail spread to his back and then the body. His coat was so beautiful and he looked very big when he had a full coat.

Q5. Did you clear the ticks in the terrace?
A. A pest-control staff smoke-bombed the area once. It could be insufficient or the ticks hatched again. It ought to be done 2-3X e.g Monday, Tuesday and Friday like what is done for fish lice. Ont time is not enough. However, the Cocker Spaniel would bring in the ticks again.

Q6. Those skin lumps in the body. When did they occur?
A. These are due to tick bites. His skin would erupt in lumps whenever ticks bite him.

So, the clue was from Q6. This Chow Chow had urticarial lumps from tick bites. A tick bite allergy leading to an increase in the eosinophils since Mar 2012. It is always good to get the history direct from the owner if only the vet will take the trouble to phone this "busy" owner who loves dogs, kois and arrowanas. And rears only the best of them. Readers may chance upon one of my earlier articles and images of kois kept by him.

 

 

Event Details:

Date: 7 November 2012, Wednesday

Time: 9.00 am - 12.00 pm (Registration starts at 8.30 am. Light refreshments will be served.)

Venue: DBS Auditorium 1, Marina Bay Financial Centre Tower 3, Level 3

12 Marina Boulevard, Singapore 018982

 

 

I will be attending the seminar.
Enhancing your business strategy” seminar by DBS.

The first speaker was an excellent presenter and is an experienced economist. For 2013, he predicted that the Singapore economy will slow down, interest rates would still remain low. Private residential properties would be in a large supply but he did not expect prices to crash.

His reasons for the 2012 slow growth in the Asian economy was due to the slow down in China investments (China being responsible for 56% of Asia) and change of China's policy towards domestic consumerism, 50 rate hikes in 2010 butt 14 rate cuts in 2011.

He said the above were the main contributing causes rather than just the euro debt crisis and the slow economic recovery in the US affecting Asia exports, as predicted by the other economists. .

Asia's manufacturing ans services would be affected in 2013

As for Singapore, 2007-2008 had a net inflow of 300,000 foreign workers in 2 years. The hikes in foreign worker policies and other fees just pass the increase cost to the customer, thereby increasing the inflation in 2011.

For the property market in Singapore, mortgage rates is below 2%. The real mortgage rate is negative. The global interest rate is so low. Therefore property prices go up.

Singapore is losing out to competitors due to a strong S$ and higher inflation. In the 4 quadrants in his chart, Singapore is on the upper left. Philipines, China, Thailand and Myanmar is in the lower right. Hongkong and Thailand is on the lower left. 

GDP Singapore is largely due to external factors. The real median income growth should be the target. The focus should not be on productivity growth factors

In conclusion, 2013 - poor economic outlook for Singapore due to slower than normal growth (cutting down foreign worker employment after the general elections) and higher than normal inflation.  
   

1169. Internship at Toa Payoh Vets - Prospective Interns to note

To Whom It May Concern

Dear Sir/Madam

My name is V...  and I am a second year veterinary student from the University of Melbourne. As part of our progression into the 3rd year of clinical placements and surgery, we are required to intern at different clinics in two week blocks to prepare us for surgical subjects next year. I would be in Singapore from the 11th December 2012 to 24th January 2013 and I would like to take on a two week placement at your veterinary facility anytime between the dates aforementioned.

I am very interested in specialising in small animal surgery after I graduate. I believe that your clinic would help me greatly in preparation for next year and that I would learn many skills from you.

I am a fast and keen learner and will work well in a team and I would really appreciate an opportunity to work in your veterinary hospital.

Thank you for your time and I hope to hear from you soon!

Warmest Regards

V... 

------------

Hi
I am Dr Sing from Toa Payoh Vets which is not a veterinary hospital. If you can work the hours 9.30 am to 8 pm on weekdays and 9.30 am to 5 pm on weekends, I will be most happy to accept you for the 2-week intern. Email to me your resume and two character references.


-------------

Dear Dr Sing

Thank you for your prompt reply! I would be happy to work these hours at your clinic. I have attached my resume (my character references included) as well as details from the school to my supervising veterinarian. I would like to enquire when would it be a good time for me to commence my placement? Thank you for your time!

------------------

Start at 9am from 11 Dec for 2 weeks. Interns should dress appropriately and be punctual and keen in vet medicine.

1168. To publish***** Urinary stones in a Schnauzer

Please inform your editor/publisher the following:

1.  To make the article useful and educational to readers, you should include the following X-ray (attached file) associated with the case study image you have had inserted.

This is preferred to a pretty face (the puppy standing around at the bottom of the article). It does not contribute any knowledge to the reader.

2. If there is no space for the X-ray, use the space taken by my photo requested by you.  I don't see my photo as being useful and educational to educate many ignorant Singapore dog owners whose dogs suffer from kidney and bladder stones. The X-ray picture has more impact on owner education as a picture says a thousand words. 

2.1  The X-ray image of the case study of the Schnauzer image you had inserted is as at:
http://www.kongyuensing.com/cgi/20120620bladder_stones_female_Schnauzer_toapayohvets.jpg.

It is attached as in this email.

3. Readers may wish to know what actually happened in my case study and you could have educated them more by printing:

To learn more about this case, goto:
http://www.sinpets.com/dogs/20120617female_dog_catherisation_singapore-ToaPayohVets.htm

4. This will be what I will do as the editor. Not just printing a pretty face of puppy or dog to adorn the article. There are millions of pretty dog images in dog magazines. These are commonly seen by your readers in every dog magazine published all over the world.

But they rarely see X-rays of bladder stones in a dog and I can bet you that your publisher has NOT published one in any past issues of your magazine. There must be some new ideas in publishing educational article in your pet magazine, rather than the usual method of generating text with pretty canine faces to adorn a veterinary article. This method is commonly done in most dog magazines published by the US and by Singapore dog magazine publishers till they are too common and not interesting.

1167. Kidney stones in a Miniature Schnauzer

The vomiting Miniature Schnauzer has kidney stones Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS 05 November, 2012

TOA PAYOH VETS  Be Kind To Pets Veterinary Education Project 2010-0129

1167. Kidney stones in a Miniature Schnauzer Yesterday, Nov 4, 2012 I attended a SVA continuing education lecture "Urolithiasis" by Adjunct Associate Professor Philip A Moses, BVSc, MRCVS, Cert SAO, FANZCVS, CMAVA, Memb AO, Specialist Small Animal Surgeon, Veterinary Specialist Services, Underwood and Gold Coast, Australia Much can be learnt from experienced veterinary surgeons. These are his advices regarding kidney stones. 1. Around 4% of the urinary stone cases are kidney stones. Therefore, always X-ray the kidneys as well as the bladder. 2. All vets should get the urinary stone analysed. It is not enough to just remove the stones and not analyse it. He cited one case where a loyal client lost faith in the vet who removed the stones the 2nd time and stones recurred again the 3rd time. Some vets don't get the stones analysed if the client is on a tight budget but this against medical advice should be recorded. 3. He would removed the kidney stone in the renal pelvis if the renal incision needed is less than 20% of the length of the kidney. For example, 1 cm incision length for a 5-cm long kidney. If it is 50% and more, it is unlikely that the kidney will function normally post-op. 4. Struvite stones and other stones do recur and this must be told to the dog owner. 5. In the US, there seems to be a higher rate in the occurrence of calcium oxalate stones. 6. As long as the vet monitor regularly post-op, most struvite stones will dissolve if the Urinary Tract Infection (UTI) can be controlled. While stones are there, there will be bacteria inside the bladder. Hence there is a need to give antibiotics even if these must be given for a long period of time. Regular monitoring via urine analysis and ultrasound are recommended. 7. "Can large struvite stones really dissolve by the dog eating stone-dissolving diets?" I asked him. "Yes," he said. "There have been reports of such cases." "Have you or your colleagues achieve success in such cases?" I asked. "No," he said. "I just remove them surgically." Owners in Singapore seldom bother to do regular monitoring though. Below are X-rays of one of my cases of kidney stones seen in a Miniature Schnauzer in Oct 2012. I advise the busy owner to do regular monitoring but this needs time from him to bring in the dog for examination. He has many things to do and so I don't know whether his dog will get a 3rd occurrence. It is costly to operate and some owners just get the dog euthanased. Yet this struvite stone disease can be prevented if the owner spends time to get the tests done.   5742. Kidney stone Nov 11? Vet 1 did not extend the X-ray area to the kidneys in this first occurrence 5742. Kidney stone Aug 12. Vet 1 did X-ray the left kidney area and a stone can be seen 5743. Kidney stone Oct 12. My X-ray shows the kidney stone too 2 months after Vet 1's X-ray in Aug 2012. 5742. Kidney stone Nov 11? 5743. Kidney stone Aug 12 5745. Kidney stone Oct 12

Images & Update at:
http://www.sinpets.com/F6/20121105kidney_stones_Schnauzer_toapayohvets.htm