Veterinary Medicine Singapore Dr Sing

485. Urine peeing anywhere. Rebellious age at 7 months

2010-04-18T14:49:00.000-07:00

The brown and white Cocker Spaniel, adopted 3 months ago, would bark when left alone in the balcony. Neighbours might complain. So she was let into the house in the first week. She was then 4 months old. Now, she would pee anywhere in the living and dining room and seldom on the newspapers in the balcony.

"What can I do?" the busy journalist who was referred to me to certify the height and weight of the Cocker Spaniel for licensing purposes, asked me. "My maid or I take the dog outdoors 6 times per day to let her pee outdoors. Yet she continues to urinate inside the apartment."

"This seems to be a case of urine marking rather than being a case of not house-broken?"
"She is a female dog," the lady reminded me.
"Some dominant female dogs do urine mark," I said.

"Where does she sleep at night?" I asked.
"In my bedroom."
"Does she pee inside the bedroom?" I expected a positive answer.
"No, no," she replied.
"Since your bedroom door is closed, she might need to pee and would then do it on the bedroom floor."
"No," the lady laughed. "I left the bedroom ajar so that she could go to the balcony to pee."

Is there any permanent solution to this problem? Each case is different as each dog has his or her own personality.

"In my opinion," I said. "You are not firm enough with your dog and so she takes advantage of you. In the first week, you permitted her to go indoors when she ought to be confined in the balcony all the time unless supervised, to be paper-trained. She tested you by barking and you just let her in. Now, she is 7 months old and her mind is not easy to train. She is equivalent to an adolescent - rebellious as she is no longer a 3-month-old puppy with a blank slate in the mind and therefore easily trained."

"What should I do?" she asked.

"Spaying her may or may not help to prevent urine marking. Start being assertive," I said to her. "For example, grip your dog's muzzle when she barks, give a light tap and say 'no barking' in a very loud and firm voice."

"She is such a lovable dog," the career lady said.
"Yet she is a wolf in sheep's clothing and has had manipulated you. She has little respect for you. So she urine-marks."

"In the dog's hierarchy," I explained, "There is a leader in a pack of dogs. This leader can be a male or female. The leader bites the subordinate dog if the subordinate goes out of line. The mother gives the pup a nip if the pups misbehaves. In your apartment, you did not display that leadership quality. So, the dog does as she pleases and urine-mark the floor to show you that she is the leader."

"I am firm towards her," the lady asserted.
"Not firm enough as this is your personality," I had observed her to be a non-confrontational personality type and asked her companion whether my observations were correct. The companion, a lady friend who was with her nodded her head.

So, what do we do to solve her problem?

1. Barking. Use the muzzle tap and voice command to stop her barking. Muzzle the dog when she barks, but for a short time of 5 minutes.
2. No water to drink after dinner at 8 pm.
3. Confine her to the balcony where there is newspapers for her to pee.
4. Positive reinforcement training. Give a food treat when the dog pees on the papers in the balcony or stop barking on command. "My dog is not interested in food treats," the lady said. "Well, the ones you give her may not press her buttons, but try and find one she is crazy about. Or reward her with play."
5. Negative reinforcement training. Many newer puppy books are talking about positive reinforcement training. But in this grown up dog, a light tap on the muzzle to stop barking or a tap on the back together with firm voice commands may be the answer at this age of rebellion. Before it is too late. Will the lady do it? It is hard to say.
6. Leash her to the dining table so that she can't urine-mark anywhere she likes. The lady had not thought of that.
7. Give her a routine daily as regards feeding, drinking and exercise. Go outdoors three x per day to pee. Not 6 X.
8. Neutralise the urine-marked spots with a piece of rag plus white vinegar at 1 part to 3 parts water. Now, the whole apartment is full of urine smells but the dog can smell it.
9. Neuter the dog. But she looked so pretty and breeding would not be possible.

There are so many suggestions I made. Since she did not take notes, as I imagined a journalist would do so, I presumed her mind would remember all. It takes a lot of time to talk to her about her dog behaviour problem. Weighing and measuring the height of her dog took less than 5 minutes. Well, I was free on this first Sunday I started work after a break in Perth, Australia. She seemed quite happy and later told my referral that she was very happy with my service.

Puppies at 4 months of age can be paper-trained effectively if the lady owner is the strong and firm type. After talking to this journalist, a couple came in with a 4-month-old brown Cocker Spaniel for the 3rd vaccination. The wife looks "fierce" and appears the dominant party of the couple from my interaction with her. So I asked, "Is the puppy paper-trained?" "No problem," she said. "The puppy goes to the newspapers every time."

Success in house-breaking depends so much on the personality of the trainer who is usually a lady. Most lady owners are the nuturing kind type and so that is where failures in paper training in an apartment arise.

Updates at www.toapayohvets.com -- TOILET TRAINING

29. High BUN - Fundamentals and Technicals in Veterinary Surgery

2010-03-26T19:19:00.000-07:00

March 26, 2010 05:58:01 pm
SMS to Dr Sing

Hi Doc Sing, I am the owner of the Silkie terrier with kidney problem who came tis afternoon...Tkns god he is willing to finish 1/3 of the can food. I will monitor closely & email the amount of water he drunk to u weekly...Thank You so muz on ur advice & helpfulness of ur staff to my dog...Thank You
Saturday, March 27, 2010. Handphone call missed. I returned call to owner.
"My dog is feverish," the young lady said. "I feel that his belly is hotter than my other dog." I advised her to use the thermometer to check the rectal temperature. "What should the normal temperature be?" she asked. "From 38.0 - 39.0 deg C." She said, "My dog's temperature was 38.4 deg C." So, there was nothing to worry.

History:
Vomiting occasionally for the past years, according to the owner. Vet 1's blood test showed that the blood urea nitrogen (BUN) way above normal, at the high end. An earlier test showed BUN was high but not that high. So, the owner who consulted me as I treated the puppy when he vomited and that was 5 years ago. Vet 1 referred the owner to another vet for ultra-scan of the kidneys, possibly for kidney tumour. What she was worried was whether the dog was in the end stage of kidney failure since the BUN had peaked.

So, she phoned me and wanted to fax over the reports. "The dog must come to Toa Payoh Vets for examination," I said. "Reading reports cannot enable me to give you correct and proper advice." In fact, it is unprofessional to advise on a serious kidney failure dog based on technical reports and no history or prior examinations of any creature or person. When the dog was presented, he was as active as a normal dog. He had excellent appetite and was not vomiting daily or every few days. Definitely he was not at the end stage of kidney failure.

Fundamentals and Technicals
I just finished listening to the audio "A Maniac Commodity Trader's Guide For Making A Fortune - A Not-so-crazy roadmap to riches" by Kevin Kerr. The commodity trading advisor, said that the use of fundamentals and technical (charts) are important if one is to succeed in trading. His website is http://www.kerrtrade.com/

For this silkie terrier, the fundamentals will be the health and lifestyle of the dog himself. The technicals will be the blood tests, X-rays, ultra-scans and others. The technical reports of blood test indicate a very high BUN and therefore imminent kidney failure. Yet the dog himself does not look as if he was going to pass away the next few days. I advised monitoring water intake, bouts of vomiting and switching to a low protein diet for the next few weeks before jumping to the conclusion that this dog was dying of chronic kidney failure. Ultra-scans are useful but expensive.

If kidney tumours are detected by ultra-scan, would the cure of surgery and/or chemotherapy be effective and would it be worse than the disease? Singapore does not have veterinary specialists in dog kidney transplant. So, what could this young lady do in the event of the detection of kidney tumours besides depleting her savings? It is possible that this dog of 5 years has a congenital kidney disease but presently, he is not at the end stage of kidney failure. Is there a cure? Unlikely unless the kidneys are infected and the infection is cured by antibiotics.

In conclusion, this case shows that both the fundamentals and technicals of the profession must be studied together to be successful in giving correct advices of a case in the interest of the sick animal as it is in commodity futures trading.

I am not interested in commodity trading as I don't have the passion for it and time to learn about a new business. I read it to learn about the best practices of another industry as some best practices are applicable to veterinary medicine and surgery.

A present of flowers and a blade

2010-02-22T14:46:00.000-08:00

February 22, 2010 (First Appointment in the Resale of an HDB apartment)

"Tonight, I will present my wife with a bouquet of flowers and a blade," the husband's first appointment at the Housing & Development Board's first appointment was aborted. The Housing & Development Board (HDB) officer had shown him a 2-page letter hand-written in big letters from his file across the table and said: "Your wife had written to object to the sale of the HDB flat. You have to engage a private lawyer or bring your wife to see me to withdraw her objection. I am sorry I can't proceed with the processing of the sale now."

This was a man in dire straits. Down and out. A bankrupt. "How do you expect him to engage the services of a private lawyer when he is a bankrupt and unemployed?" I asked the HDB official. I was helping Realtor Khin Khin in her first case and after a caveat lodged by a bank of this man's first buyer, I thought this first appointment was a formality. The racehorse had galloped past the turn and was in the straight heading towards the finishing post.

The Buyer's Agent, a slim serious looking housing agent who had just given the HDB officer the original letter from the Official Assignee (OA) approving the sale of this HDB flat said, "The private lawyer could be paid from the proceeds of the sale."

The HDB officer flashed the OA's letter at her: "I am sorry to say that there will no proceeds from the sale for the Seller." He meant that the OA would grab all the monies on completion of the sale. So, no money to pay a private lawyer's fees which would be at least $1,200 in cash. More if the case is complicated. This man in dire straits was hanging around a shopping mall according to Khin Khin who frequented the same place. Therefore he could not be gainfully employed.

"If the private lawyer is paid, is there a guarantee that the sale can proceed if the wife still objects?" I asked the HDB officer, a pale-faced trim man with reddish brown hair was sympathetic but he would not give any legal advices. Why should he take the risk?

However, he was a kind man as he gave this man in dire straits a second chance, during his lunch-time next week. He could just postpone the next appointment several weeks later if he exercised his powers. The HDB officials are very helpful in some of my experiences of dealing with them.

If this man in dire straits, at the pits could not sell his HDB apartment, the HDB would force sell at 90% of valuation. That meant he would lose at least 10% of the sales proceeds. Although he would not get any cash at the completion of sales, he still would get money returned to his Central Provident Fund (CPF). The OA would return all his CPF monies from the sales proceeds to the CPF before paying the other creditors. I calculated that the balance would be around $5,000 for the creditors.

With his wife's objection lodged without his knowledge 2 months ago, he was fixed. If the HDB forced sale his apartment, he would lose out a lot of money.

As we left the HDB, I knew that this man was pushed to his mental limits. Would he be committing murder? I asked him "Why do you want to present your wife the flowers and the blade together?"

"Well, she has to choose one or the other," the man in dire straits said. "It will be best if you can arrange a meeting with your wife and I together to talk over," I knew that this man had suppressed his emotions and his frustrations for many months. I was surprised that he was not involved with the loan sharks as his HDB apartment was spared the spraying of paint and vandalism. He and his wife were residing there in peace. If he could complete the sale of his HDB apartment, he could have some freedom to travel overseas to work. Now, the OA would not permit him to travel overseas as he did not "contribute" to return monies to the debtors.

It is not easy to contact this man by phone as his top-up card and phones keep being "lost". Now, there are 7 days to wait and see.

27. Chinese New Year 2010's interesting cases

2010-02-16T14:49:00.000-08:00

Report written at Toa Payoh Vets: Feb 16, 2010. Chinese New Year (CNY) 3rd day. Still a holiday. I wrote the following since I was quite free.

CNY reviews of interesting cases.
During Chinese New Year, almost all Singapore small animal vets close. Feb 14, 2010 was Chinese New Year and also Valentine's Day. Toa Payoh Vets do open half days during Chinese New Year. During last Chinese New Year, I had no cases and so I thought the same would happen this time. However, there were a few cases. Vomiting and diarrhoea in dogs accounted for 3 cases. The following were some interesting cases for dog lovers.

Case 1. Hypersexuality in the male dog.
The career lady was in charge of a regional publishing operation and had no time to take leave. She planned one month ahead and took several days' leave to care for her Miniature Schnauzer after neutering as advised by me. Her dog had inflamed areas in his groin region due to humping and licking.

The dog was groomed first. Multiple rashes on his lower body. Treatment for 4 days. Then I neutered him and sent him home 4 hours after neutering. He would be given Tolfedine 60 mg at 1 tablet per day. I phoned the lady and she said that the dog felt no pain and was just normal. I told her that the urine analysis showed that the dog has no urinary crystals unlike the previous test in which some triple phosphate crystals were found. The dog had spermatozoa in the test, as in previous test. Why? This male dog had an anti-social habit of humping onto legs and pillows, injuring his groin area. I hope neutering would help as he is already 4 years old. Neutering before 1 year of age would be best. This owner slims her dog down now as she cooks for him. No more dry dog food. She takes good care of him and I expect this dog to live up to 20 years. He is only 4 years now and may outlive me as I am 15 times older than him.

"You can't shout at him," the gentle lady boss told me. When I commanded the Schnauzer in a firm voice to be still on the examination table, the dog suddenly turned around and opened his mouth to bite me. I just withdrew my fingers in time. No tough love for this dog. But no gentle kind words from me. I muzzle him instead.

Case 2. Medial Entropion. Shih Tzu, 7 kg, Male, Neutered, 1 year, 39deg C. Persistent eye tearing since puppyhood.

The Shih Tzu is well known for medial entropion causing life-long tearing and irritation but few owners are aware of a simple surgery to resolve the problem. Seldom does the owner bother to take the surgery. A case is recorded below for the benefit of vet undergraduates. Name of surgery: Nasal fold excision. I didn't know there is such a surgery.

Admitted: Feb 2, 2010
Surgery 1: Feb 5, 2010
Surgery 2 (left eyelid tearing on day 6, right eyelid has no tearing): Feb 11, 2010. Excised a bigger elliptical skin area below and lateral to the medial canthus. Rolled out the left eyelid more. Took out stitches of right eye area to review. Wound opens up as the area is under tension and has not healed firmly as it was 6 days only. Has not healed 100%. Re-stitch.

Tolfedine 60 mg (1/2 tab/day) x 10 days
Baytril 50 mg (1/2 tab/day) x 6 day
e-collar, eye drops
Daily cleaning of eyelid area is necessary for the next 10 days
Nylon 5/0 stitches to be taken out on Feb 25, 2010
Goes home on Feb 17, 2010 (pictures taken on Feb 16, 2010. Phoned owner at 10.30 am wakening him up.)

Case 3. Anal sacculitis or circum-anal tumour.
Miniature Pinscher, male, 5 years with hard lump on left anal sac area. Anal sacculitis/circum-anal tumour surgery. Heals well. Goes home on Feb 16, 2010. Is this a circum-anal tumour? Still Alive And Kicking - Circum-anal tumours. Should the dog get a second anti-androgenic injection and be neutered? Many owners are against neutering deeming it to be a cruel act. Or in this case, the dog is deemed too old and a anaesthetic risk. So I do not pursue the matter further as the owner may think that I am soliciting business from her and from the owner's point of view - this is patently obvious. Update: 2004 tips for young and older dogs

Case 4. Torticollis (head tilt) in a rabbit.
CNY 1st day. Rabbit, female, 2 years, 1.7kg
Feb 14, 2010 (Chinese New Year).
Left head tilt. Sudden onset at 1 am (loud noises heard). Left eyelid wide open. Nystagmus. Right eyelid injured as rabbit lies on right face. Keeps rolling to try to get up.
Ear canal - blood in cotton bud seen from deep inside the ear canal. Irrigate ears.
Prednisolone, Meloxicalm oral, Biolapis, Fiberplex. SC dextrose saline and baytril. Sent home the 2nd day as she could stand but with head tilted. Less Nystagmus. The lady owner to nurse and hand feed. No blood test or X-rays for the time being as this would increase vet costs.

CNY 2nd day.
Case 5. Suspected high fever in a hamster.
White dwarf hamster, Male, 14 m,
Eyelids closed. Not eating 2 days. Sleepy for 2 days
Young teenaged boy was upset that his pet became sick when he was in China for 9 days.
SC dextrose and Baytril and eye drops.
Day 2 - conjunctivitis and tearing esp. right eye (photography) and dehydration - will need electrolytes. Eating. Stools passed but only a few pieces. Not a good prognosis.
Owner to disinfect hamster cage, feed bowl and water bottle.

CNY 3rd day. Still a public holiday.
Case 6. Deep ulcerative keratitis in a Chihuahua.
Chihuahua, 2.6 kg, 38.8. adopted for 2 months. Abandoned. Eye cataracts. Possibly >8 years old. Male. 2.65 kg.
Right corneal eye ulcer very deep. Blood spots. Past 2 weeks. Why the delay? The owner thought it was a small matter.
Anaesthesia is high risk as dog has heart disease. Bad teeth. Eats only wet food. Big right flank abscess > 4cm x1 cm
Really eating? Owner asked to bring food to Surgery for me to check. 3rd eyelid flap on day 2.

Case 7. Poodle, Male, 2 years. Dental scaling. I was surprised that the lady owner made an appointment for dental scaling for a young dog. Rarely do Singapore owners bother at this age. Grooming 3-monthly and regularly yes. The external beauty is a priority.

But teeth check up once a year? No. This young dog eats home-cooked food and no dry food. So plaque and tartar form in the back teeth. Daily brushing will resolve all problems. Some dogs don't like teeth cleaning. This lady may be one of those more sophisticated ones who know the importance of dental health to enable her dog to live longer.

Case 8. A tele-conversation with a pet owner. One owner complained that his dog had been losing weight since being warded. His vet prescribed many types and sizes of capsules containing nutrients and vitamins for his old dog to "prolong his life". Yet the dog lost weight while he was warded. He said he was not given progress reports. The dog would not eat when brought home as he was force-fed. I don't make comments in this case as I only get one side of the story. Just provide a listening ear as I am sure that there will be owners with grievances against me as a vet.

Case 9. A tele-conversation with a new vet undergraduate. Young people prefer texting. I prefer phoning to thank Daphne for her help in producing 2 educational videos for vet students recently. Creating educational videos to bring veterinary surgery alive. She had been an intern at Toa Payoh Vets. I gave her my very best wishes for her new adventure as a veterinary undergraduate in Australia. She saw 5 beautiful Miniature Schnauzer puppies at a practice and was saying how cute they were. New-born puppies always tug's a lady's heart strings. I told her I did not perform the Caesarean section but was taking pictures. Oxytocin injection and wait or an elective Caesarean section?

This 2010 CNY was not a quiet day unlike 2009 CNY. My main lesson is from the feedback in Case 8. It is important that the vet does daily rounds of in-patients and check records of weight loss and appetite as a routine no matter how busy they are. Phone the owner to update and to phone the owner to visit the pet if the pet is dying. Before the pet dies so that the owner can pay the last visit. I wonder whether this is taught at veterinary schools for the 5th year students.

26. A pet shop operator's capsule

2010-01-30T12:29:00.000-08:00

"My children are grown up and so I don't have any responsibilities now. I have a capsule," the pet shop operator said when I asked him how he would cope if he were to suffer another stroke. He was paralysed some 4 years ago and now he is normal. He could talk to me like any normal person and so he has recovered fully. His various tablets enabled him to live a normal life but his weight has not decreased.

We had known each other for over 30 years. His son had grown up to take over his thriving business. His wife is an excellent dog groomer.

I visited his pet shop this sunny weekday evening as he had invited me a few times when he brought puppies for me to vaccinate. He had shifted to another location as the old one was put up for en bloc sale. I was impressed with his big pet shop with a large inventory of various brands of dog food. I can judge how successful a pet shop business is by the inventory of dog food. Nowadays, dog food sales are not on credit terms as many pet shops close every year. So his large inventory means he must have a big clientele of dog owners in this relatively affluent area of Singapore.

I could see a Caucasian woman in her late 30s taking back a well-grown red miniature poodle from the shop and admiring it outside where her silver sports Mercedes was parked. Besides other clients, a woman in her 30s came in to buy her big bag of dog food and recognised me first.

"My Husky does not bite his tail anymore," she said. "However the patch over the tail gland is hairless," she promised to e-mail to me a picture. What a coincidence as I had not been to this pet shop for at least 2 years as it was quite far from Toa Payoh.

I seldom visit pet shops nowadays as I have so many things I want to do. "How much it costs to feed your Husky?" I ask this young lady with 2 Huskies and a small car. I always wonder how she could pack in 2 Huskies in such a small car to the dog park.

The pet shop operator has her loyalty as he gives loyalty cards which entitle buyers to discounts and some privileges. As for me, I wonder if the loyalty card system to retain clients applies to the vets. In theory it should. In reply to my query on feeding costs, the lady said, "Excluding canned food which I feed in the evening and two meals of dry food (Pinnacle brand) a day, it will be S$36.00 a month. So, it is S$1.20 a day.

Returning to my mission to get the pet shop operator to change his lifestyle, I said to him, "I read a book written by a doctor specialising in heart attack cases. It mentioned that heart attack patients would revert back to the old life-styles after a while," I sipped the Chinese tea he poured into a small tea cup for me.

"Yes, I was very afraid of death for the first few months after my stroke," the operator told me. "Now, my doctor said that I have so many tablets to take. I ought to be OK eating all my favourite seafood, pork-belly meat and laksa (fat-filled noodles with prawns). After all, my children are grown up and I have no more responsibility." His wife could take care of herself.

His wife and son had voiced their worries about his life-style to me when they brought the puppies for vaccination and I enquired about the head of the household.
I said I would talk to him sometime. Many months had passed. Here I was now visiting his pet shop. He had become an invincible man as he did not reduce his weight, did not exercise much nor become a vegetarian. After all, his doctor had prescribed him all the medication to prevent another stroke. If all fails, he certainly had a plan - a capsule to end his life if he were to suffer another stroke.

"If you have stroke, you will be paralysed. How will you be capable of taking this capsule? In any case, the ones who suffers most will be your wife and son, rather than you if you die. They have to take care of you 24 hours a day while you remain paralysed. Have you thought of this?"

He did not reply. I did not probe further what type of capsule he had but I am sure he had some medical knowledge to do what he wanted if he suffered another stroke.

"A friend recommends me to take the tablets from India to slim down," he told me. "My friend says it works for him."

I was surprised that he did not learn from a well known medical case where an actress who took slimming tablets made in China had to accept a liver transplant from her boyfriend. Another woman taking the same pills had actually died. I reminded him of the case. "It is best to stop taking such pills, cut down drastically on your fatty food. Do more walking. Weigh yourself daily. I can say you avoid the weighing machine so as not to know you have put on weight, am I right?"

"No, I don't weigh myself any day," the operator laughed. "It is hard to stop eating all the fatty food. After all, my doctor tells me he has prescribed medication to lower the high blood pressure and the cholesterol level in the blood. So I should have no problems."

Just take the medication and all strokes will be prevented. It is not so simple as that. One's liver will be tolerant to the medication and that means the medication dosage needs to be increased or the type changed.

Some people just need to eat at different hawker stalls and restaurants, sampling different types of cooking. What is living if one does not live to eat? Eat to live, more vegetables and fish and monitoring the weight weekly is far from the mind of most recovered heart attack or stroke person. What can be done to help loved ones to change their lifestyle?

Sometimes, changing one's unhealthy lifestyle or becoming vegetarian will do and the medication may be dispensed with in some cases, with the doctor's regular check up. It is hard to be alive and eat the bland vegetable, fish diet and fruits most of the time for many years. I believe that such a regime works. So far, I am nearing 60 years of age and have not needed any medication for diabetes, heart attacks or strokes. So far, so good. As for the operator, I hope he stops taking the slimming pill made in India if he does not know what it contains. Otherwise, he may suffer liver failure rather than a stroke! I will follow up on him.

25. Maroon bluish tongue

2010-01-29T14:01:00.000-08:00

The colour of the tongue tells a lot about the prognosis. In this case, I showed the owner that the dog's tongue was abnormally maroon and bluish. "In my experience, dogs with this colour of tongue and a dry tongue is going to die soon. Your dog also has heart disease."

"I require a blood test in this case as this was the second time the dog had poisoning signs and his kidney and liver may be damaged." The owner gave her consent.

Shih Tzu, F, 2 years.
Presenting Sign: Salivation. Non-stop vulva licking for 2 days upset the owner. The pest control people fumigated the apartment the previous day for a second time.

Tentative Diagnosis:
Insecticide poisoning. Unknown insecticide used by the pest control people.

History
4.8 kg 39.3 deg C. Jan 19, 2010
Pest control came yesterday. Salivation. Vet 1.
IV treatment, atropine recovered next day.

4.2 kg 39.8 deg C. Jan 27, 2010.
Pest control came yesterday.
Dog started salivation. Non-stop watery and profuse. Vulval itchiness seen as continuous licking. "She passed black stools," the owner said. "The dog had bleeding in the stomach from insecticide poisoning," I replied.
The tongue colour - maroon red and bluish and dry. A sign of poor health. Is she going to die soon?

Blood test results:
Liver SGPT/ALT above normal
Kidney Urea above normal.
Creatinine below normal.

Haematology:
Haemoglobin above normal. Red cell count normal but total White Cell Count was above normal. PCV above normal. MCV above normal. MCHC below normal.
Insecticide unknown. IV treatment, atropine and Lasix IV. But no vomiting or coughing. Recovered and went home after 2 days. Tongue became normal pink after 2 days of treatment. The dog went home.

However, if my assistant tried to open the mouth to for me to take photograph, it turns bluish. The dog does not show signs of heart disease presently.

The apartment floor should have been thoroughly cleaned as I presumed that the pest control man must have fogged the whole place it to death.

The dog had stepped on the chemicals and her private parts had been burned chemically, hence the non-stop vulval licking on presentation. She was doing it all the time on the consultation table.

The pest control people had fumigated the apartment twice at 7-day intervals. They must have exploded a big bomb of chemicals into the apartment and blanketed the whole place with insecticide poison. The dog was contaminated when he walked he floors and licked away the strong smelly poison as best as she could. Her mouth started drooling. She got intoxicated and infected by bacteria as her total white cell counts were raised. Fortunately, she survived the two poisoinings.
Blood tests cost money and increase veterinary fees. If the dog dies, a blood test will answer some questions regarding the possible causes of death. This result gives some owners and the family members some answers and a closure. Otherwise there might be some doubts regarding the veterinary treatment and competence.

Update and pictures are at: www.toapayohvets.com

24. Subluxation hip Golden Retriever puppy 4.5 months

2010-01-28T13:59:00.000-08:00

Case 1:
Danish lady in her 30s with mum.
Purchased from the same pet shop.
Golden Retriever 3 months.
Consultation: Came for 3rd vaccination. Puppy purchased 1 month ago.
Housing: A house with a small garden
Feeding: 2 times per day as advised by the seller. Wolfs down food fast.

This case was a lot of fun for the mum. Every time Alice, a 4th year vet student put the puppy onto the electronic weighing scale, he dashed off the scales elsewhere. Alice had to catch him again. She placed him on the scale. Before she could read the weight, the puppy sprinted off making the mum laugh. Alice and I looked serious as such incidents happen with other puppies too.

Toilet Training: Newspapers 100% covering playpen. Then reduce the covered area as advised by the pet shop puppy seller.
"What happened during the first 7 days?" I asked. "Did he poo and pee onto the newspapers?"

"The puppy was confused and did it everywhere inside the playpen. After 5 days, the puppy now eliminates onto newspapers in a separate half of the playpen.

"How did you train him to do it?" I asked.
"Lots of praises. Praise him and give treats when he eliminates on the newspapers." Successful paper-training due to hard work and training.

Question 1: When can the puppy go out to the grass to eliminate? The owner did not want the puppy to do it in the small garden.
The seller had advised going out till after the 3rd vaccination to prevent parvoviral infections.
The puppy can go out to places where there are no dogs or puppies e.g. pet shops, dog runs, boarding houses 2 weeks after the 2nd vaccination. However, 2 weeks after the 3rd vaccination, the puppy can mix with other dogs as he has full protection against the lethal parvoviral and distemper viruses.
"Put the newspapers with urine smell onto the grass outside, so that the puppy will commence eliminating outdoors," I advise. "It is a good idea," the owner said.

Question 2: When does my puppy get his heartworm vaccination and does he need one?
It is best to protect him against heartworms which is present in Singapore. Vaccinate at 5 months of age. She will make an appointment.
Clinical Findings:
Ears full of wax but no ear scratching surprisingly. I advised the puppy to go back to the pet shop seller to get ears cleaned. I advised deworming for intestinal worms once a week for the next 4 weeks.

Conclusion:
This puppy will have plenty of love and great fun exercising outdoors since he lives in a house and can get out without the problem of having to bring him to the lift and go downstairs. There is a small garden but he will not be permitted to go there and destroy the plants. But he can go outdoors easily compared to Case 2.

Case 2:
Australian gentleman in his 30s
Purchased from the same pet shop over 2 months ago. Paper trained on a pee pan. Now apparently lame. Owner was worried about hip dysplasia.
Golden Retriever 4.5 months. All 3 vaccinations done.
Feeding 3x/day. Poops 3-4 times per day.
Purchased puppy 2.5 months ago.

Consultation: Dog has "hip dysplasia"
Housing: Condo with smooth marble and wooden floors.
Playpen: Sleeps at night with bed.
Toilet area: Pee pan + newspapers in the balcony. Feed and water bowl in the balcony.

HISTORY: Last 2-3 weeks, in the morning, the puppy had been walked for around 30 minutes. The puppy would stop walking after some distance. But he had to do it. In the evening, he would be exercised. Sometimes he would be at Sentosa to swim. Lately, he was lame in his hind legs. great difficulty standing up using the back legs in the morning. Has great difficulty moving down slope or moving down from the car seat. No problem getting up the car as he used his front legs.
"Could this be hip dysplasia?" the young man asked. "What should I do with this puppy?"

EXAMINATION:
1. Outside the surgery.
General visual examination of conformation and muscle of the back leg - cow hocks with right hind having toe out.
Gait - The owner walked the dog up and down concrete flooring on a loose leash - no obvious lameness on slow walk. Puppy was said to "hop" on 3 legs at a run.

2. Inside the surgery.
On the examination table, put the puppy sideways on his left and right side to manipulate the joints.
Abduct and adduct hips and all other joints of the hind limbs - no pain surprisingly.
Put puppy standing and extend 2 hind limbs - right hind limb is shorter than left hind.
Back muscles of right hind are smaller than left hind.
Spinal cord pressure - no pain in general. There seemed to be some mild pain at the lumbo-sacral spinal area. Could this be the cause of pain in the morning on waking up and being unable to get up normally as a young puppy should?

HYPOTHESIS FOR SPLAYED HIND LIMB AND SUBLUXATED HIP:

"Where does the puppy spend 90% of his day?" I asked.

"Inside the apartment," the man worked from home and therefore knew what he said.

"Does he walk on very smooth marble flooring when at home?" I asked although I know the answer since all modern condos are marble-floored and wooden-tiled with waxy wood.

"Yes. The wooden flooring upstairs are also very smooth, being waxed."

Based on my experiences with the professional dog breeders, I would say that this puppy had no chance to walk on firm surfaces as they are usually crated before sale.

Therefore, the Golden Retriever's hind legs become splayed slightly before sale. The splay was not very obvious as he did not walk like a cowboy if you don't observe closely.

He had also cow hocks which would account for his "hip dysplasia" style of walking with the hocks lower and right toe pointing outwards.

In addition, he was over-exercised in the morning going to the school with the children for the past 2-3 weeks. He had over 30 minutes of road walk. "He was keen to go out in the morning," the young man said. "But he would stop walking after some distance."

"He had pain in his hip area," I said. "So he stopped walking". "Sometimes, he hops," the man said. Sparing weight onto the hind limbs," I said.

"The puppy could climb up the car but would hesitate to climb down from the car later," the man gave me this good clue to pain in the hip area. Climbing up involved the front limbs. That was OK for the pup. Climbing down involved the back limbs and hip area. There was pain. Similarly to getting up in the morning using the hind limbs. There was some pain in the hip area. But none was elicited or shown when I palpated, extended and flexed the hips. Or the knees. So, it was very difficult to prove my hypothesis to the young man.

There was muscle atrophy in the right hip area would indicate some pain in the right hip area for some time. This was accepted by the young man.

I pressed the hip joint. Yet there was no pain response from the puppy. I extended both hips to compare the length of the hind limbs. The right hind was noticeably 3 cm shorter. But there was no pain.

The puppy now splayed his hind limbs out and flopped onto my examination table. He had enough of all these palpations. He was a very friendly puppy and had not bitten me once. As I pressed the spinal area from the neck to the tail, there was a very slight pain at the lumbo-sacral area. I don't think the young man saw the response as it was very slight.

This pain and the subluxation of the right hip joint could account for the difficulty in standing up on the hind limbs.
"Is there a cure for the hip dysplasia?" the man asked. "Must he be put to sleep later?"
"I don't think he has hip dysplasia now. He has subluxation of his right hip. He will recover if you let him rest for at least 4 weeks and confine him to a rough floor area for the next 3 months. No over-exercising. Let him walk and run within his limits rather than force him to do more road walk. No morning road walk.

For hip dysplasia, he needs to be over 6 months of age for X-rays to confirm. His history indicated over-exercise (probably running up and down the 2-level condo with the children) and just having too much of a good time. A very active life-style."

The puppy lies down with hind limbs splayed out unlike other puppies with limbs tucked under the abdomen. This was observed and pointed out by the owner as the puppy flopped onto my consultation table. "With a smooth flooring over the past months, the puppy's hind limbs stretched outwards and now he just splays his hind limbs outwards when he lies down. With a rough flooring, his hind paws may be able to get a grip to stand up."

The last paragraph supported my hypothesis that this puppy had a lifestyle that caused splaying of his hind limbs. As he grows older, the splaying is not obvious. However, his right back muscles were not well developed compared to his left. Both had poor development considering that the puppy "hops" when over-exercised.

DIAGNOSIS:
Right hip subluxation but not so serious to cause obvious lameness. This accounted for his occasional hopping when he runs.
ADVICES:
1. No over-exercising for the next 4 weeks and preferably 3 months. He should have no walking exercise or running up and down stairs for the next 7 days but confined to the balcony-part-living room area.

2. X-rays of the hip would be done at over 6 months to properly confirm hip dysplasia. Presently he is 4.5 months.

3. Chances of him recovering are good. 50:50 if he continues to walk on floors where his legs can get a grip. A garden would be best but this dog must live in the apartment for the next 5 months of lease. So, what to do?

4. "Install anti-slip mats onto the flooring. Confine him to a room with baby gate or use the kitchen and utility area for him when he is at home," I said. This was not practical advice as there was no room and the kitchen was small for such a big breed.

"The balcony?" I asked. "Will it be too hot when the sun is out?" The man said, "Yes."

"Where does he sleep nowadays?" I asked.

"A big playpen near the balcony." the man replied. I asked him to draw the floor plan. He would fence up part of the living area next to the balcony and connect this area to the balcony. His plan was good as the puppy would be confined to and have over 15 sq metres of anti-slip space to walk when staying at home.

CONCLUSION:
The gentleman propose converting the corner of the living room near to the balcony into a fenced up area with anti-slip mats. So, the puppy can walk to the pee pan and newspapers in the balcony for his toilet and back to the living room to see the family. No more free roaming on slippery smooth floors and he should recover fully. I prescribed non-steroidal Rimadryl tablets for 7 days.

I am quite confident that this puppy will be fully recovered as he was sent to the vet early. He has an enlightened and educated owner who has not delayed seeking veterinary advice unlike many Singapore puppy owners who don't bother after the three vaccinations and seek advices from the groomer.

A house will be best for this puppy but a condo has so many facilities for the expatriate family with young children. In any case, by the time the lease ends, this puppy should be normal as the owner knows what to do and his wife has the architectural knowledge to execute this floor plan for the puppy. If the expatriate had waited for some time, this puppy would have dislocated his right hip and it will be very difficult to recover. This is a case where clinical signs were presented at home. At the vet, the puppy behaved quite normally. There are many such cases and the owner's history and observations count a lot more than clinical findings. Some puppies or dogs just behave normally at the vet as they have a high tolerance to pain. Showing pain is not good for survival in the wild and this may explain why the puppy shows no pain readily. He may not have very serious pain and so suppress it in front of the vet who is a stranger to him. Is this another hypothesis? As for hip dysplasia, we would have to wait and see.

23. Moral ethics and economic reality in carnaissal tooth abscess

2010-01-20T13:25:00.000-08:00

Old dogs do suffer from carnaissal tooth (maxillary 4th premolar) abscesses and unless the vet has not diagnosed the non-healing facial wound as due to the abscess, the owner will need to consult him or her for several months. Medicines will be given and yet the facial wound still does not heal. If the diagnosis of this oro-nasal fistula is correct, the only option is surgery to remove the infected tooth. Unfortunately, the dog is old, in poor health and has a high risk of dying on the operating table.

When told of a high risk anaesthetic death on the operating table, many owners opt for no surgery. The dogs become older and sicker. Finally, the owner has no choice. It would be a prolonged painful death or a possible death on the operating table.

Vets are not Gods. It is foolish for the vet to say that the dog has a high percentage of survival when the dog is in poor health. Well, if the dog has a poor chance of survival, the vet must be no good. The vet can sense that there is a loss of confidence in him or her. There is a tension in the consultation room air when the owner expresses his or her sentiments about the failure of treatment. What should the vet do?

Advise the owner to seek second opinions rather than continue conservative medical treatment for several months. Is it morally ethical to milk the owner as a cash cow knowing that surgery will cure but the risk of anaesthetic death on the operating table is extremely high.

If the vet feels that it is too risky to do anaesthesia on old dogs or pets, ask the owner to seek other vets who may take the risk and ruin his reputation. Death on the operating table spreads like wildfire on the pet internet forums but the reality of the situation is that the dog will not be cured on conservative medical treatment. Therefore the owner must be told firmly and given written notice to prevent misunderstanding.

Economic reality may override the moral ethics in a private practice with so much competition and high overheads. The staff and associate vets see what you do if you are the leader in the practice. Do the right thing by asking the owner to seek treatment elsewhere once the owner has had lost the trust in the veterinary-client relationship with the vet. Vets are not Gods. Deaths on the operating table will present themselves and bad-mouthing do spread like wild fire when you handle high risk anaesthetic cases in old dogs as there will always be owners who delay treatment or ignore veterinary advices till they have no choice except surgery.

In this carnaissal tooth case recorded here, I did not phone Vet 1 as to why medical treatment and cleaning of the facial wound were performed for one year for "sinusitis" due to a yellowish nasal discharge from the left nostril for one year. The owner had confirmed that Vet 1 had diagnosed correctly the condition. "He just would not operate on the dog." This was the point of view of the owner whose mother was the one in contact with Vet 1. The mother would have to visit him many times to seek a cure. Finally, the son took the high anaesthetic risk to get the dog operated.

A blocked left nostril with yellow discharge. A cyanotic tongue indicating a lack of oxygenated blood or toxicity. These symptoms signal high anaesthetic risk.

This 11-year-old Chihuahua was in excellent body condition, not being thin. I auscultated the heart. Surprisingly, she had no heart disease. These were the pluses but still one cannot be too complacent.

Only 11 out of 42 teeth existed and they were loose ones with tartar built up over the years. Vet 1 had done one dental scaling some years ago. So, there was a good veterinarian-client relationship with the owner's mother. But that facial wound. That rubbing of the left eye. That left nostril discharge. These had gone on for almost 12 months. The mother could be stressed out. In real life, it is the aged parents who feel so much more for the companion dogs since the children have left the nest and have practically no time for the senior citizens. So, it would not be a surprise to me if this case had become extremely volatile and emotional for the mother and family members.

The irony of this case is that surgery would cure. Yet Vet 1 just did not want to do it due to the high risks involved. In such cases, I would pass the buck to other vets. In this case, the son took matters in his hand to seek my opinion. He accepted the high risks. We had never met before. Much was at stake for the mother. If the outcome was good, the mother would be most happy as this Chihuahua is family to her.

I used isoflurane gas anaesthesia with no sedative injections. It was difficult to mask the dog as she had this left nostril discharge. I intubated using a smaller endotracheal tube. This type of cases must be on short anaesthesias to achieve a good outcome. The vet must have all instruments ready. I even had the dental scaling machine switched on just in case it was needed.

The 11 teeth were extracted. It was possible to leave the canine teeth alone to impress or comfort the owner that the chihuahua had some teeth.

But that would not be in the interest of the dog. They were only slightly loose. But I know that this old dog would get gum diseases later and this would be her only chance under anaesthesia. So, I took out all the teeth.

7 days later, I phoned the son. He was quite grateful and said: "Mum does not need to wipe away the runny nose (left nostril discharge) or clean the tearing eye (left facial wound, dog rubs itchy wound and eye). I know I will never see the mother who must be in her sixties. She is now a happy mother and there will be peace in the family after 12 months of worries. I did notice a swelling on the right cheek and a possible carnaissal tooth abscess on the right side. Now, since all 2 carnaissal teeth had been extracted, I would not see a case with two oro-nasal fistulas - a rare case.

More pictures of the case are at: www.toapayohvets.com

22. Injectable Anaesthetics - Dogs + Cats - Siem Reap, Cambodia

2010-01-15T15:40:00.000-08:00

Thursday, Jan 14, 2010. I visited The No. 1 Animal Place, 645 Hup guan Street, Siem Reap, Cambodia today. I thought it was a pet shop with fishes, birds, rabbits and hamsters for sale. Puppies and kittens are never sold here. The operating room is upstairs. The following is practical anaesthetic knowledge shared by an English lady vet graduated from London. She practised for one year in Siem Reap.

DOGS
Xylazine 2% 0.05ml/kg
Ketamine 5% 0.3 ml/kg (human ketamine is 5% i.e. 50mg/100 ml unlike veterinary ketamine which is available as 10%).
Separate syringes, one injection another instead of waiting 15 minutes as this was found to be more effective. IM injection.
Onset 10-15 minutes (to sleep)
Duration 20-25 minutes (before topping up)
Top up: Mix above 2 drugs in one syringe and give at half dose.

CATS
Xylazine 2% 0.1ml/kg
ketamine 5% 0.2 ml/kg
Both drugs in one syringe
Onset 5 minutes
Duration 45 minutes
Top up: Mix 2 drugs in one syringe and inject.
Disadvantage: Wakes up suddenly. Wait 5 minutes before proceeding to surgery. Takes a long time to wake up. Vomiting. Tends to vomit with dogs and cats even on empty stomachs. For sick cats, the dosage is reduced by 1/3.

REVERSAL
Yohimbine use in cats to wake them up sooner. No need to use in dogs in her cases. Rapid recovery was obtained with Yohimbine in cats in her experience. Is it possible that her xylazine dosage was higher such that the cats take a longer time to be mobile? See Discussion below.

DISCUSSION
CATS around 2 kg in Singapore Toa Payoh Vets, www.toapayohvets.com
I use Xylazine 2% @ 0.1ml and Ketamine 10% @ 0.4 ml in one syringe IM
Onset 5 minutes
Duration 20 minutes

Comparing this to the English vet's formula, she would use
Xylazine 2% @ 0.2 ml
Ketamine 5% @ 0.4 ml (Since I use 10%, this would be equivalent to 0.2 ml)
Her dosage permits her a longer duration of 45 minutes. She needed 15 min pre-op. She needed a reversal drug which i don't need.

That meant she used xylazine 2% @ 0.2 ml and ketamine 10% @ 0.2 ml while I used xylazine 2% at 0.1 ml and ketamine 10% at 0.4 ml.

DOG, 5 kg Jack Russell
Xylazine 2% @ 0.25 ml IM
Ketamine 5% @ 1.5 ml IM (For me, it should be 0.75ml for 10% ketamine I use).
Worked very well for her. Recovery is smooth.
Separate syringes.
Ketamine 1.5 ml is large amount. It stings and is painful for dog. Dog bites. Muzzle dog.
Top up, use one syringe.

As I don't use above for dogs, I am happy to receive her valuable feedback. I use Xylazine 2% at 0.2ml IM, Wait 5-10 minutes and gas mask isoflurane and intubate.

RABBIT
In a practice in England, the following is used for anaesthesia, according to the English vet:

Domitor 0.1 mg/kg
Ketamine 10% @ 10mg/kg
Torbugesic 0.5mg/kg
In one syringe.
Need to monitor rabbit. Stops breathing. Give reversal Antisedan.

Rabbits do not need to be starved prior to anaesthesia unlike dogs and cats since they are incapable of vomiting and the most common post-op problem is intestinal stasis. They should be given hay as soon as possible to prevent post-operative ileus or gut stasis.

Sedation
Domitor 0.1 mg/kg
Ketamine 10% @ 5mg/kg
Torbugesic 0.5 mg/kg
In one syringe.

NOTES: Torbugesic (butorphanol) produces additive effects when used with other sedative or analgesic drugs. In horses, 0.1 mg of butorphanol/kg IV is recommended for the alleviation of visceral pain. Ketamine is a dissociative drug that is analgesic and does NOT depress cardiovascular function. Xylazine causes muscle relaxation, sedation and analgesia.

Molar spur trimming (injectable anaesthesia sufficient without gas anaesthesia.
A common drug combination in rabbit anesthesia is butorphanol (Torbugesic) and midazolam (Versed). Butorphanol is an opiod with analgesic (pain-killing) and sedative properties. Midazolam is related to diazepam and produces sedation and muscle relaxation. Anaesthetic induction can be gas or a combination of ketamine, midazolam and xylazine. Propofol is a new drug that is expensive but relatively safe. It is not known how it works.

Spaying and neutering are not popular in Siem Reap in 2009. The majority of the locals don't vaccinate, spay or neuter nor feed commercial dog food. Parvovirus is rampant from puppies imported from Thailand. The small animals at this Shop is part of the business model to get clients coming in. In Singapore, it will not be permitted if there is no separate entrance for the pet shop and vet surgery premises. A thriving fully equipped vet practice in Phnom Pem has been started by a French vet for many years.

In countries like Cambodia and Myanmar, it may be too expensive to set up a gas anaesthesia machine for small animals. Therefore injectable anaesthesia is commonly used by the local vets.

21. Defensive Medicine Costs More

2009-12-28T12:41:00.001-08:00

From: ...@starhub.net.sg>
Subject: Bill for treating wound and removal of maggots
To:
Date: Monday, December 28, 2009, 12:08 PM

As spoken, I enclose a copy of the bill itemizing the treatment of my Husky. In your professional opinion, is the bill justified? I know there is nothing I can but at least I want to know that I have been overcharged or not?

Thanks.

Regards
Name of owner
E-MAIL REPLY FROM DR SING

1. It was nice talking to you yesterday. Thank you for your e-mail of your vet's bill. As I have not seen the extent of the wound and was not present, I cannot say definitely whether you have had been overcharged when you said you were billed over $600 for treatment of a maggot wound in your large breed dog. The total bill was $641.20.

2. My comments are that I don't usually conduct the following for the treatment of maggot wounds performed by your vet, viz.,

2.1 Heartworm test $50 (not relevant to maggot wound treatment).
2.2 General Health profile $150 (some vets perform this test to screen the dog's health prior to sedation).
2.3 (Insecticide) Interceptor Spectrum $65
2.4 Buster Collar 25 cm $23
2.5 (Insecticide) Negasunt powder $18
2.6 (Pain-killer) Rimadyl Inj $30
2.7 (Pain-killer) Carprofen 50 mg $9

Therefore, the costs would be reduced $345 and your final bill might be $641 - $345 = $296 assuming I used the same procedures as your vet. No 2 cases are exactly alike, just as no two condos for rent are exactly alike. I am using condo rentals are an illustration since you are familiar with this industry.

3. However, I do hospitalise the dog for 2 days for observation if the maggot wound is deep and large. I don't know how deep is your dog's maggot wound. In addition my consultation fee is $10 more than your vet. If you shop around there is at least newer vet practice charging consultation fee at $18 which I believe to be the lowest in Singapore.

3.1 If you deduct $296 for the above case, my fees may be considered cheap at $200-$300 range, since I don't use items in paragraph 2. But some owner may have the perception that I am not a good vet since I don't give the extra drugs what all good vets should give and I had not practised defensive medicine by doing general health blood test and heartworm test.

4. I use the real estate rental of a condo as an example since you are familiar with this topic. An owner in the same condo may rent out his apartment for $5,500 per month and you would get a rental of $6,500 per month.

4.1 Will you be considered a greedy landlord since you are overcharging by $1,000 compared to your neighbour? You may claim that your quality of renovation, furnishing and furniture is vastly superior in quality and this may be true. Prospective tenants usually view various condos. This would probably be the case, as I know that is a common practice. No tenant will rent the first condo they see in Singapore. Supply is greater than demand. On the other hand, your tenant at $6,500 rental for your condo has the company budget fixed at $6,500 and may have other disbursements from you. So, your $6,500 rental may be justified. Still it appears you are overcharging if the market rental is $5,500. If there is such a thing as market rental. There is no fixed charges for veterinary treatment by the way.

5. Some dog owners do phone up vet practices to get quotations and then go to the cheapest vet in town. When the fees need to be kept low, obviously, the dog does not get general health blood test, painkillers and Buster collars. Some owners have built a client-veterinary relationship of trust and goodwill and the vet will act according to the owner's financial means in the best interest of the pet and the client.

6. Back to the condo rental industry, if the tenant wants a low rental, he has to sacrifice for the poorer quality of furnishing. If the pet owner wants the least veterinary cost, he has to scout around and find the least cost veterinary practice and there are such practices if you do your research.

7. I am sure that this dog with maggot wound will heal beautifully and that your daughter will be most happy. Call for quotations from vets all over Singapore next time.

8. In conclusion, I would say you are overcharged by $50 since vets in general don't consider the heartworm canis test necessary in the treatment of a maggot wound.

8.1 On the other hand, your vet may need to know that your senior dog did not have heartworms as he could have died when given sedation and the Interceptor Spectrum. Your vet could be sued for "medical negligence" for not checking whether your senior dog had heartworms and pre-sedation blood test first before sedation was given.

Defensive medicine is a good defence against litigation and veterinary complaint investigation. This apparently had been practised by your vet and you were charged for the higher costs.

8.2 Your dog was given the best things in veterinary medicine and it burnt a small hole in your pocket. You said that the practice was not a famous one equivalent to the human "Mount Elizabeth Hospital", but had you gone to Mount Elizabeth-equivalent, your bill would be more than $600.

8.3 It is really hard to compare as there is a vet practice that will treat a maggot wound for around $100 - $150.

9. Shop around if you want the cheapest service provider. Inform the vet that you are in dire straits so as to get the least cost treatment. No frills. A house brand rather than branded goods. Ask for steep discounts and drive a hard bargain before the treatment. Risk being blacklisted or shown the door for a few dollars less.

9.1 I relate a personal incident I suffered recently. One day, a door-to-door vendor came to my surgery to sell goods. I bought a "Made in China" belt from him for $10.00 to give him some business since I know he needed some income as door-to-door sales are extremely hard work with more rejections than sales.

The next day, the buckle fell off and threads start peeling off the belt. I had to throw away the belt. So, was I being cheapskate? I should have bought a Pierre Cardin belt at $58.00 and would not have to show my clients that I wore a belt without buckles. It looked as if I was down and out. In dire straits. But my clients did not say a word and I shopped around for a "branded" belt 2 days later. Prices of goods and services vary greatly and if one goes for the cheapest, one should not be surprised at getting shoddy goods or services.

10. I hope my reply is entertaining and to your satisfaction and put a smile on your face. I wish you a Happy and Prosperous Chinese New Year.

20. Against Medical Advice

2009-12-23T12:48:00.000-08:00

Profuse salivation after de-ticking by the groomer yesterday. The owner sent the dog to the emergency vet. Dog was given charcoal tablets and sent home. The owner was told to return in 2 to 3 days' time for a blood test.

Yet the dog started to salivate again in the morning. I was consulted. No more ticks. The owner was worried about the salivation and some shivering.

"Did you apply a 'Spot-On' insecticide onto the spinal area earlier?" I asked.
"Yes," the owner said. But ticks were still present and so she went to the groomer to get de-ticking done.
"The groomer must have applied a tick wash," I said. "Did the dog lick his paws and body?"
"Yes," the lady replied. The dog looked all right. There was some wet whiskers seen, due to salivation.

The dog was bathed thoroughly before its coat was clipped short. An IV Hartmann's solution was given. It was bathed again after clipping. Around 1,000 ml of IV drip was given to dilute the poison if possible. The owner wanted the dog home on the same day despite my advice to wait for one day for observation.

So the dog went back at 9 pm. This was one of those cases that should be warded for one or two days for observation, but the owner decided against medical advice and must be respected.

Day After My Treatment
The owner phoned me to say that the dog was not behaving normally. However he was eating and had no vomiting, salivation, shivering or diarrhoea. "It will take around 7-14 days to recover if the insecticide poisoning has not affected the brain, liver and kidneys," I advised.

The groomer phoned me and so I was able to know what had been used. The owner had phoned him earlier and so he phoned me to find out about the dog. He had used 1 cap of the Carrington Dog Wash Concentrate in around 800 ml of water. "No complaints from most owners," he told me. "Except for a few cases of salivation."

"This dog could have licked the insecticide from the matted hairs in its paws," I said. "The owner did not accept my advice to de-matt the paw hairs," the groomer said. So, the insecticide could have accumulated inside the paw's matted hair and the dog could have licked it and started salivating. However salivation is a sign of insecticide poisoning.

This is a case likely to result in negligence complaints and litigation if the dog has died. The vet and groomer have to be very careful nowadays. So far, so good.

P.S.
Carrington Dog Wash Concentrate contains pyrethroid insecticide and is sold in some Singapore pet shops. Not all dogs need to be warded for suspected insecticide poisoning but some dogs such as this case would be advised as the IV drip needs to be given over 24 hours. If owners go against medical advice, give the owner a release form stating that the owner wanted the dog to be discharged immediately and by 9 pm in any case. I did not give the release form in this case and sometimes this omission would haunt me if there was litigation.

Spot-on insecticides are said to be ineffective for some dogs but effective in others. A spot-on insecticide and a tick wash sometimes cause profuse salivation in dogs, depending on dosage. Owners who acted against medical advice should be given a release form to sign to protect the veterinary practice against litigation.

12. Paraphimosis in a 5-year-old Cavalier King Charles. What to do?

2009-12-15T11:29:00.001-08:00

DRAFT
Updates at: www.toapayohvets.com. Goto DOGS - Surgery webpage - balanoposthitis.

Paraphimosis - protrusion of the penis with an inability to retract the penis into the prepuce.

Causes:
1. Idiopathic - No known causes
2. Small preputial orifice
3. Weakened preputial muscles
4. Trauma
5. Shorter prepuce

Possible medical conditions
1. Posthitis - Inflammation of the prepuce.
2. Phalitis - Inflammation of the penis.
3. Balanitis - Inflammation of the head of the penis (glans penis).
4. Balanoposthitis - Inflammation of the head of the penis and the internal layer of the prepuce.

Treatment:
1. Surgery to prevent balanoposthitis?
2. Retract prepuce to the level of the bulbus glandis and wash it with soap and water every day.
3. Others?

Dec 16, 2009.
The case is being reviewed for the next 2 weeks as the dog is given medication.

The small preputial orifice got swollen 6 weeks after the first treatment. This could be due to the dog's lifestyle - humping on cushion though he is neutered at 2 years of age (belated) and sunbathing for 15-20 minutes a day nowadays.

When the inflammation is gone, surgery may be the only option as daily pulling back of the internal layer of the prepuce to wash away the smega and pus may be too much work for the young working lady owner.

18. Ticks in Singapore dogs

2009-11-08T16:26:00.000-08:00

Non-chemical control is safe for the dog, the family and the environment but many time-pressed Singaporeans do not think this way. They just buy an insecticide from the pet shop or the internet, apply it on the skin between the shoulder blades of the dog and this method may keep the dog tick-free for a month. In time to come, they find that the insecticide does not work.

Non-chemical control is as follows:
1. Dog booties. The dog wears "shoes" when taken out to dog parks or outdoors to exercise.
2. On coming home, examine all the toes carefully for any small ticks attached to the skin between or below the toes. This simple method reduces tick infestation considerably in houses with gardens.
3. Groom the dog daily but this is asking too much.
4. Cut the grass short and trim the lawn.
5. Keep the dog in one part of the garden or kennel so that any tick infestation will be in one area.
6. Clip long coat short if there are many ticks.

Pest controllers in Singapore do a roaring trade fogging and spraying insecticide into every park and space to kill mosquitoes. All these insecticide just goes to our reservoirs and kills us in years to come.

As a dog owner, you can play a small part in not introducing more insecticide in your home or garden by using non-chemical methods to control ticks in your dogs. Surprisingly, fleas are uncommon in dogs as we don't use carpeted floors unlike the culture in Australia.

16. Stray cat with large growth

2009-09-29T12:13:00.000-07:00

Sep 30, 2009
To:
...@gmail.com>
Thank you for your follow-up. There are at least three courses of action for you.

1. Discuss with your parents as to why they object to the surgery. Is it due to religious reasons or due to the surgery being a waste of money since this is not your cat? Much depends on whether you are a good negotiator. Negotiating skills are not inherited - young adults in Singapore seldom have such skills, in my opinion. Read books on this subject. as the library has many. I hope you can acquire such skills early.

2. Ask your friend to bring the cat to a vet for surgery and adopt the cat. I presume it is a stray cat that is unfortunate to get an abnormal lump.

3. Do nothing till the cat falls sick when the growth is very large, rubs against the floor. Friction causes open wounds. Wounds get badly infected with maggots or bacteria and becomes very smelly. Maybe your parents have no objections at that time. Or the cat needs to be put to sleep due to ill health and pain.

It is extremely hard to diagnose over the internet or to see pictures. Therefore I will not hazard on the nature of the growth - tumour, encapsulated abscess, cysts, haemotoma, hernia and other conditions.

Subject: Re: Fwd: Cat with tumour on the belly
To: "David Sing"
Date: Tuesday, September 29, 2009, 12:28 PM

Hi Mr.Sing

I am not able to bring the cat for surgery as my parents are against the idea even though I am willing to pay for the surgical fees. Nonetheless, I would like to thank you for the detailed information on the tumour/hernia. The cat is constantly under my supervision and she is in a good shape.
I have a distant cousin from Malaysia and he is a vet too. He examine the cat and touched the area of the tumour. He said that it feels lumpy and it is as if there is water inside. He's not really to sure either. He said that I should bring in for surgery.

If you could advise on this matter, I would be grateful.
Many thanks,

On Mon, Sep 14, 2009 at 7:07 AM, David Sing wrote:

Pic shows a big tumour or inguinal hernia. Cannot tell from viewing pic. Tumours are found in middle to old aged animals. Cause of breast tumour in cats unknown. Continue with existing feeding as the cat may not eat if you change brand. Change later. No food and water after 10 pm the night before surgery and on day of sugery. Bring in the cat at 9 am if possible. Last week of Sep OK if cat is not in pain.

Subject: Fwd: Cat with tumour on the belly

To: "David Sing"
Date: Sunday, September 13, 2009, 2:50 PM

Hi Mr. Sing

Attached for your reference.
Yes, it's a female cat. I'm not sure about the age of the cat, though.
I will try to bring her for the operation asap.

What's the cause of the breast tumours? Is it deadly?
In the meantime, what are the recommended food should I give her? I've been
giving her Whiskas all these while but I heard from a friend of mine, who
is a cat lover herself, that Whiskas are considered fast food for cats. Is
it true? She told me to buy the can food, Fussies for Cats. However, I have
not feed her with that yet.

What are the procedures to take before I bring her for the operation?
Will the last week of September be okay?

Hope to hear from you soon.

Many thanks.

Regards,

On Sun, Sep 13, 2009 at 8:22 AM, David Sing wrote:

> thank you for pics. looks like one or more big breast tumours. I need a pic
> from below, not just side view. is it a female cat? $300 is the lowest fee
> for such an operation for you. Hospitalisation and nursing for a week will
> be free if this is a stray cay.

> Subject: Re: Cat with tumour on the belly
> To: "David Sing"
> Date: Saturday, September 12, 2009, 3:25 AM
>
>
> Hi Mr Sing,
>
> Attached for your reference.
> Hope it helps.
>
> Thank you.
>
> Regards,

> On Sat, Sep 12, 2009 at 7:18 AM, David Sing
> > wrote:
>
>> pictures will save time

>> Subject: Re: Cat with tumour on the belly
>> To: "David Sing"
>> >
>> Date: Friday, September 11, 2009, 2:08 AM
>>
>>
>> Hi Mr. Sing,
>>
>> The tumour is inside the cat's stomach, to be exact. It's quite huge and
>> it dangles when the cat walks.
>> I'll try to get a picture of it.
>> The problem is, it's not my cat.. So, my parents and I are contemplating about the fee. But i'll try to talk it out with my parents.
>> Thanks a lot.
>>
>> Will get back to you soon.

>>
>> On Fri, Sep 11, 2009 at 7:04 AM, David Sing
>> > wrote:
>>
>>> Estimated fee is around $300 if tumour is on the skin. best to let us
>>> examine and give quotation

>>> Subject: Cat with tumour on the belly
>>> To: judy@toapayohvets.com
>>> Date: Thursday, September 10, 2009, 11:56 AM
>>>
>>>
>>> Hi,
>>>
>>> I would like to enquire on the surgery price of removing a tumour on a
>>> cat's stomach.
>>>
>>> Thank you.
>>>
>>> Regards,

FINAL REPORT AT:
www.toapayohvets.com

15. Heart failure in a young Pom

2009-09-26T16:03:00.000-07:00

"Your Pom has less than 1 week to live," I examined the one-year rapid panting and gasping for breath open-mouthed Pomeranian with a pad wrapped around her backside. "If you can't help her to breathe normally."

2 days ago, the Pom coughed blood, splattering red clots onto the apartment's floor. Vet 1 had warded her and advised euthanasia a few times while the dog was treated past midnight, according to the owner. "Your dog would need to be hooked up permanently to an Oxygen mask," Vet 1 had said. "Yet, I did not see the dog with the oxygen mask all the time during treatment," the boyfriend commented to me. I did not say anything as it was one side of the story.

In the morning, Vet 1 discharged the dog while another Vet 2 from the same practice gave a second opinion and medication. Vet 2 said: "This dog will live from 1 month to 1 year."

48 hours later, I was consulted, being referred to by the owner's 2 friends. It was kind of Vet 1 to give the two X-rays of the heart to the owner so that there was no waste of time for second opinions. Even the Singapore General Hospital where I had a chest X-ray recently does not do release X-rays to the patient.

"The vets said that this tablet will reduce the size of the enlarged heart." I shook my head. "Or stop it becoming more enlarged." I did not comment as there might be some mis-communication. I need to check this medicine out.

The dog's heart was beating too fast. I passed the microscope to the Temasek Polytechnic Vet Technician intern so that he could hear abnormal heart sounds. "Can you hear the 'whooshing' heart sounds in the stethoscope?" I asked him. "Normal heart sounds are distinct." He nodded his head. I offered the stethoscope to the young lady. She declined. This was too stressful. The dog was about to die from heart failure soon. His tongue was purplish.

However, I immediately gave an injection of 20 mg furosemide from the one ampoule of Lasix IM in the left muscle of the thigh. There was hope. Then the dog was crated while I showed the lady pictures of the normal heart in X-rays from Ve Medicine text book.

"Is it dangerous to the heart if the dog has more than 1 X-ray?"

"No," I said. "Your dog had only 2 X-rays at Vet 1 and never had X-rays before."

"Please take another X-ray," the lady said. I was surprised by this request.

"The X-rays from Vet 1 are excellent," I advised that there was no need for more X-rays. However the lady insisted. It was 10 minutes after my Lasix injection. The young Pom was barking loudly and her breathing was normal. She passed out a lot of urine. Lasix had reduced the amount of water in the lungs by getting the kidneys to increase urine floe. The onset of diuresis is within 1 hour. So the dog felt normal now.

As the duration of action is 6-8 hours, I got the Pom X-rayed 4 hours later by Vet 4. It was also good to discuss this case with him. Vet 4 proposed cardiac ultrasound to check whether there was pericardial effusion which could be treated via ultrasound imaging. Also, ultrasound could reveal any disorder of the tricuspid valve.

"Would the Lasix resolve any pericardial effusion?" I sought his opinion. He nodded his head. He had one case of success in draining the pericardial fluid from a dog who is still alive.

"The owner is concerned about the cost, saying she had spent $800 at Vet 1 and 2." Now, X-rays and a cardiac ultrasound could add up to $400. Vet 4 reduced his fees while I forgo my consultation fee so that this Pom could get the ultrasound done.His fees were a low $171.00. I appreciated his kind gesture. I charged $96 for the medications. The dog went home on a strict advice to stay at home and 3-hourly medication for the first week and communication with me. No no more fun and exercise at East Coast Recreation Park.

"How log will this dog live?" I asked Vet 4. "Vet 2 had said up to one year."
"Vet 2 is a bit too optimistic. This dog is unlikely to live past his 2nd year birthday."

The lady owner was extremely sad. This was a young dog. A present from her boyfriend. With compliance to taking drugs, a proper diet and giving medication when the dog started panting past midnight, the Pom is still alive at this time of my record today, Sunday Sep 27, 2009. It is only 7 days since the Pom coughed out blood, but there was no more horrible panting episodes.

Full record and updates will be at www.toapayohvets.com

14. A canine coup d'etat

2009-09-19T16:20:00.000-07:00

"Why did you go to the SPCA at 2 pm to abort the scheduled euthanasia of this old dog?" I asked the couple who requested me to euthanase the dog as it was in poor haelth. One lethal injection and the vet gets his payment for his services.

"It was mum who sent the dog to the SPCA," the wife said. "She is very old and is unable to take care of the dog for my brother who is in hospital now."

This case reminded me of the various coup d'etat in Thailand. A coup is the sudden unconstitional removal of a legitimate government. In this case, the legitimate owner is in hospital. If his faithful companion who sticks to him through thick and thin is put to sleep suddenly, there will be reactions.

I asked the couple to ask the two pre-teen children to wait outside the examination room and advised: "The owner will find that the veterinary certificate of euthanasia with the cause that the dog is in poor health or cancer is incredulous. There will be high emotions and possibly bodily harm to family members. High emotions may lead to mental instability and murders."

The couple was silent for a while. They had not anticipated such extreme possibilities.

"You know the owner's temperament well," I said. I could also foresee litigation and even my demise by attackers unknown, due to acts of vengeance. My retribution for euthanasia of an old dog in a canine coup d'etat. This scenario sounds hilarious to you readers, but murders of passion do occur in any society.

Such cases must be handled carefully by the vet. Written permission must be obtained from the real owner. Analyse what is the problem. The main problem seems to me that the mum could not care for the dog. The solution was for me to board it at minimal cost. The couple took the dog home after 7 days.

I did not follow up such cases since I don't have the funds to help out the owner. A "PDSA" institution like that in the UK for dog owners unable to pay private vet fees will be good for such cases but nobody in Singapore has got one started.

13. Heath Screening 7-month-old Golden Retrievers

2009-09-11T16:38:00.000-07:00

--- On Fri, 9/11/09, ...@gmail.com> wrote:

Subject: health screening for new dogs
Date: Friday, September 11, 2009, 12:39 AM

Dear Doc,

I want to adopt a 7 month old golden retriever (local cross breed
maybe) from my friend. It's not microchipped yet, so we want to implant
one for it and have a health screening.
Our most concerned disease is parasite toxoplasmosis gongii. I heard
this parasite can infect human and result in miscarriage. Although my
wife and I don't want to have baby yet, we don't want to have this
risk in future.
Hence, besides this T. Gongii testing, what else testing do you suggest?

We really love dogs. I also bought another pedigree golden retriever
from a renowned pet shop. They are specialized in golden retriever
breeding. This dog is also 7 month old, female as well. I want to have a health
screen for her too, cause people from pet shop said they can only
garantee me 24 hours for refund. So can you give me some suggestion
about how to test it?
I have checked her body. She looks quite good, but I am afraid of her
teeth. The last few teeth look like in grey color. I am not sure it's
due to some disease or just hygiene problem. As a matter of fact, I
did ask them to brush her teeth for me, but after that, the
improvement was negligible and bad breath still present.

Thank you doctor for your help! They are coming next week Thursday,
therefore I need to make sure we have enough preparation.

With kind regards,
Name

E-MAIL REPLY

Re: health screening for new dogs - dr sing
Friday, September 11, 2009 11:34 PM
From: Dr Sing

To:
...@gmail.com>
1. Thank you for email.
2. Regarding pedigree golden retriever with bad teeth and bad breath at such a young age of 7 months, it is best you don't buy her.
3. A general health examination including eye exam will be done. Cost is S$65.00/dog. Blood test to check blood system, liver, kidney and diabetes cost $150/dog. Toxoplasmosis blood test is separate charge, estimated to be around $100.
4. A 24-hour guarantee from the dog seller does not give you much time to know whether the dog has had been infected with the serious parvoviral disease if the dog is just infected prior to purchase. Disease shows itself 7-14 days after infection.
5. In 7-month-old dogs, you may need to check for stomach worms (stool sample), heartworms (blood test) and parvoviral infections (blood test). Approximate costs for the 3 tests $150.

Best wishes

P.S. Don't buy a dog with bad breath.

13. Create attractive graphic designs to educate pet owners

2009-08-05T16:44:00.000-07:00

Graphic Design Essentials: Skills, Software and Creative Solutions
Joyce Walsh Macanio

LAYOUT - Path Layouts

A good path displays the objects of the page or print such that the reader's eyes read all its contents in a meaningful sequence. Start with a focal point to hook in the reader.

Focal points can be formed by:
1. Make an object a bright colour
2. Make an object dark.
3. Emphasie a compelling image or word
4. Sharpen one object and the others softly focused.
5. Object has a different texture or gloss.
6. Object has colour but background is black and white.
7. Change the value of the object to create contrast with the background
8. Unusual direction or position on the page for the object
9. Object isolated on the page.

Integrate Type and Image
1. Readers will read if you place your headline near the focal point or along the path.
2. Accents such as supporting images and text are placed to lead the eye through the page. Repeat colours, shapers and textures to create flow.
3. Vary size and color of text. Headline is the largest and brightest. Yellow against blue for example. Small logo in corner in white. Small dark copyright info at bottom left or right.

11. The Case of the Rat-Catching Westie

2009-05-22T12:52:00.000-07:00

"I have no objection to letting you have the blood samples to give to Vet 1" I said to the two women in their 20s on this fine sunny morning at 9.30 am. My associate who consulted in the evenings and Saturdays had treated the Westie yesterday and told the owners that he suspected liver and kidney diseases. He had told them that the blood samples would be sent to an outside laboratory today. My associate had said that the results would be available after 2 days.

However Vet 1 could produce instant haematological results and the 2 women now wanted the blood to be given to Vet 1 whose instant blood test results would tell them whether the Westie was suffering from liver and kidney diseases.

I checked the case card. The complaint was that the Westie had stopped eating. I had given this 10-year-old Westie dental scaling 2 months ago and he was all right during general examination. I had not requested blood test prior to dental work as that meant extra expenses to the dog owners. Most don't like to pay more and many Singaporean dog owners don't even send their dogs for dental check up and would live with their bad breath for years.

"I am open to owners wishing to have 2nd opinions. But have you considered that Vet 1 may not be elated to receive your blood samples collected by his competitor? He may want to collect blood again as he may not trust the blood from my Surgery. He may say that the blood collected overnight will not be good for the test and therefore he has to collect fresh blood for analysis.

Human behaviour is unpredictable. If he is not happy, do you expect your dog to be well looked after? I had bad encounters with 2 vets in this practice before. When two of my owners wanted the dogs to be treated by them, I made prior phone calls. The two vets were very busy and judging from their phone conversation and mannerism, they would rather not get 2nd hand cases.

The 2 ladies had not thought of such behaviour but they do exist. "In any case, your Westie had been barking for at least half an hour and he sure did not look as if he was going to die soon." My associate had given the necessary IV drips and treatment yesterday evening and I would rather not interfere with his case to avoid confusion.

The apparently elder of the two ladies asked, "If Vet 1 collects blood again, will the blood test be different and affected by the treatment given?"

"Yes," I said. "Your Westie in the animal holding area was barking non-stop for at least 30 minutes this morning. He did not look as if he was going to die soon and therefore needed instant blood tests. In any case, blood test results from this laboratory can be available within 24 hours if we request urgent results"

The ladies vacillated. To go to see a new vet or not to go. Doctor hopping leads higher expenses.

I asked my assistant to bring the Westie into the consultation room for me to examine and then release for the 2nd opinion. There was no point in retaining this client. Mr Saw brought in the Westie and put the dog on the consultation table. The dog stood quietly as I opened his mouth. I showed the gums to the ladies and they could see that the dog had almost white gums. "Your dog has severe anaemia and blood tests would be very useful to help the vet know what is the cause of the anaemia."

Then I palpated the anterior abdominal area. As I felt the stomach area, the Westie shivered and gave a grunt of pain. The two ladies could hear and see his reaction.

"Did you feed chicken bones to this dog?" I asked. "Does he pass black smelly stools and had difficulty passing stools sometimes?"

"Yes," the older lady nodded their head in reply to the 3 questions. "I feed him chicken bones every day."

"Some chicken bones could have lacerated his intestines over the years causing bleeding in the intestines leading to black smelly stool formation. Some fragments of bones could be passed through undigested and got stuck in his rectum temporarily causing pain in passing motion. The prolonged episodes of bleeding would have caused severe anaemia. Of course kidney disease and other internal organ diseases can cause anaemia too."

"What else do you feed this dog?" I asked.

"Well," the older lady said. "He likes to catch rats when I exercise him around the coffee shop. Sometimes he would bring me the rats behind the coffee shop."

I was surprised that this 10-year-old senior could still hop around to catch rats. But he looked compact and solid. Some incipient cataracts but he was living his life to the fullest by catching rodents.

"Have you read in the newspapers about two people dying after eating rojak in a Geylang Serai food court?" I asked the two ladies.

"Yes," they could not connect the topic of food poisoning deaths in two human beings with their Westie's severe anaemia but were too polite to tell me.

"Well," I said. "Some patrons of this food court said that there were many rats in the food court running around."

Rats are common in food courts and they can be large and plump. They hide inside the sewers near the food court.

So what has rats in Geylang Serai to do with this Westie's severe anaemia?

I postulated, "The government authorities instituted a cleaning up. I am sure that the pest exterminatiors would be called in to get rid of the rats. Other food court operators in Singapore would take similar actions. They would use rat bait poisons to kill the elusive and fast-running rats beside other methods.

"So what?" the ladies sent me their thoughts by telepathy and awaited patiently for the connection.

"It is possible that your Westie had eaten rats poisoned by rat poison. More rat bait poison granules would have been placed on the areas where the Westie went hunting. They are attractive to dogs too. So, it is possible that your Westie had ingested them. The poison went to his blood system and destroys his red blood cells. So, he developed internal bleeding and showed this severe pallor of his gums and tongue. The blood results should come in within 24 hours if you are still interested in me sending the samples this morning."

The ladies spoke to each other and decided to wait. In the meantime, I gave this Westie 2 ml of Vit K1 subcutaneously. My associate had given the Westie intensive IV drip and that was OK.

Later in the evening, the blood results came in by fax and I informed the ladies that the Westie had very low red blood cells and platelets.

The next morning, the ladies visited the Westie. Mr Saw brought the dog onto the consultation table. The Westie moved his head away and struggled and preferred that I did not open his mouth. But I had to. What would be the colour of his gums?

The ladies gasped in surprise. Not really as Chinese ladies seldom express their feelings so opening unlike Caucasians. There are a reddish glow in the gums compared to 24 hours ago. As if the Vit K1 was an antidote and had helped to produce more blood. Of course there was the protein and other IV drips given to this dog. But the results were spectacular. From snow white to a reddish tinge. This was what counted.
Not just talk and talk.

To cut a long story short, the Westie was warded for around 5 days. His blood tests showed he had kidney and liver malfunction as well. This could be related to his suspected rat bait poisoning.

The important thing for the two ladies was that the Westie had regained his gum colour at the end of 5 days and could go home much alive and eating.

As for his rat-catching days, I guess that the ladies would retire him. In this economic depression, the Westie would be considered retrenched as his services were no longer required. But he would never be homeless or be deprived of tender loving care till the end of his life.

UPDATED STORY
goto www.toapayohvets.com or www.bekindtopets.com May 2009 serial.

A veterinary-client relationship of trust and respect: Great Dane Tick Fever

2008-08-26T12:35:00.001-07:00

DRAFT - Google Docs
Written Toa Payoh Community Library
Aug 26, 2008 6.46 pm

A veterinary-client relationship of trust and respect benefits this Great Dane

Tuesday Aug 19, 2008
Lethargy, anorexia, fever and pallor past 2 days.
"My Great Dane had a few ticks during the past few days. Now he is not eating and sleeps a lot. He looks pale in his gums. Can it be tick fever? Can you make a house-call?" the caregiver asked me.

"If it is tick fever, do not delay. I will get a pet transport man to bring the dog down to the surgery."

"Can I come tonight?" the caregiver said.
"If it is the starting of tick fever, come down now to get the dog treated before the disease overwhelms him," I advised.

At 3 pm, the caregiver in her forties, with hair dishevelled and frown lines all over her face brought the Great Dane to the Surgery. The 2.5-year-old male giant canine sauntered into the Surgery. He had never been sick and therefore had not been to the veterinary surgery for the past 2.5 years.

Fever confirmed. It was 40.2C. Moderate pallor of gums and conjunctiva.
Two men carried the giant onto the table. 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
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.
Caregiver was cooking liver. Dog ate when caregiver hand-fed bits of liver.
Caregiver showed me that she had bought 0.9% NaCl from a general practitioner and 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," caregiver said. "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.
"When did the Great Dane recover?" I asked.
"On Sunday, he was so hungry and ate all food."
"It must be due to Imizole and medication," I forgot to acknowledge caregiver's role.
"It is due to my extra vitamins and cooking of liver for him."
Her boss came to the surgery to get vibravet for ten 10 more days as caregiver was busy updating pricing of pet products.

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 follow up on this case.

9. Epilepsy in a 7-year-old Miniature Bull Terrier

2008-08-14T11:20:00.001-07:00

Toa Payoh Vets Clinical Research
Making veterinary medicine alive
to a veterinary student studying in Australia
using real case studies and pictures
Epilepsy in an older dog
The owner has to accept the high risk that his epileptic old dog may die on the operating table

Baxter's owner consulted me one day some two years ago for a second opinion. Baxter had been licking his paw and one big red skin lump of over 2 cm in diameter appeared. Vet 1 had recommended surgery to remove the growth.

"It could be a lick granuloma," I said. "Let me know if my anti-inflammatory injection and antibiotics worked. You still have to clean the skin lump daily."
Surprisingly the lump disappeared as I anticipated that surgery would be required for such a big lump.

I visited Baxter a few times as he always go to the owner's office. He jogged with the owner every morning and was as slim and fit as the owner.

When he had a fit on May 14, 2008, the owner phoned me: "What is the cause?"

I referred the owner to the competition as I wanted the owner to have a different opinion. Fits are hard to treat unless the cause is known and so a different opinion would be good for Baxter. One of the causes of fits is bacterial infection of the brain. Now, Baxter had a very foul breath in 2008 and would not let me examine his mouth. His owner could not do it too. Despite several advices to do dental check up, the owner was not keen. General anaesthesia in an old dog would be risky and Baxter might die.

So, it was better to have a bad breath dog rather than a dead one from an owner's point of view.

On August 10, 2008, Baxter came in after suffering 6 fits within 24 hours.

"I gave Baxter 'steroids' in his rectum twice," the owner said. "The other vet had given them to me in May when Baxter had his first fit."

"What is the name of the 'steroids?" I asked. "They must be rectal diazepam tubes". As the owner did not bring his medication to me, I asked him to go home to get them.

The 'steroids' were 5 mg rectal gel tubes named 'Stesolid'.

Now, how should this case be managed? There was one possible cause of Baxter's epilepsy. A high fever caused by bacterial infection. The source of the bacteria would be most likely from the foul mouth. There could be other sources but the mouth had plenty of stinking bacteria. A high fever would cause the fits but since Baxter was given 2 rectal tubes of diazepam which controlled fits and lower the body temperature, Baxter had no fever and no fit on his arrival at the surgery.

"It is never easy to diagnose the cause of epilepsy in any older dog," I said to the owner. "Blood and urine tests will be taken for testing. It is possible that bacteria from the decayed teeth have had caused a high fever and damaged Baxter's brain."

Baxter did not have fits now. He was given an IV drip of 5% dextrose saline.

I said to the owner: "You have to take the risk of Baxter dying on the operating table today. He may die under general anaesthesia to remove the decayed teeth to get rid of the bacteria. This may be the last time you will see Baxter alive."

Anaesthesizing a dog with epilepsy is very high risk. Why not wait till his epilepsy was controlled. But procrastination might give time for more bacteria to further damage the brain tissues. It was possible that the physical damage of the brain by the bacterial toxins had been done. It was better not to wait.

At this time, I felt quite angry that the dental work could have been done after Baxter's first fit and before that. The owner just ignored my advices and I felt sorry for Baxter whenever I see him. Only 2 weeks ago, Baxter's owner took me around Mount Sophia with Baxter to pick up some 'organic' mangoes littering the roads. They were organic in the sense that the mango trees were not farmed commercially and therefore are healthier with no insecticides. I went with Baxter and the owner to gather some mangoes and Baxter appeared his drowsy self. Baxter seemed to have a very high tolerance to toothache as in many dogs of the bull terrier breed.

The owner would be worried that Baxter would die under general anaesthesia. Baxter had no problem during his first general anaesthesia when I removed 9 loose teeth some 2 years ago. But he was much older now.

From the owner's point of view, why tempt the God of death?

But what choice has he got now? 6 seizures. More would come. The owner understood and accepted the high risk of general anaesthesia. If Baxter had a seizure during anaesthesia, he would die. And it was hard to forecast when the next seizure would come.

Baxter had 2 vials of diazepam rectally given by the owner. So he could not fight back much as I put the gas mask onto him. He could still move his mouth away with his muscular neck and two men had to hold onto him.

The minimal gas amount was used. No intubation was possible as he had a very painful mouth. Ulcers and bleeding in the gums.

20 loose teeth were removed. 4 strong canine teeth and a molar with exposed root were the remaining strong teeth left. Baxter did not have a fit.

He survived the general anesthesia. Then he had a fit 2 hours later. And more seizures. Was his brain irreversibly damaged now? How to help him live a normal life? More veterinary follow ups are necessary for Baxter.

The record of the history and follow up to August 14, 2008 is written below.
Thursday, August 14, 2008
9. Epilepsy in a 7-year-old Miniature Bull Terrier (draft blog)
Epilepsy - 7-year-old Miniature Bull Terrier

May 14, 08. One fit. I asked the owner to consult the competition as it would be good for the owner and Baxter to get a different first opinion. Causes of fits in the older dog are notoriously difficult to find out.

The vet said that there was nothing abnormal in Baxter's blood test and examination. The vet prescribed phenobarb 30 mg and advised 2.5 tablets 2 times per day for 2 weeks. The owner was told that Baxter would need the drug for life. Baxter did not complete the 2 week of medication. As to the cause of this fit, it was not possible to pin point. The owner had antibiotics given. I advised dental examination under general anaesthesia some months before and even after the first fit to remove bacteria multiplying in Baxter's mouth. Baxter had objected to any mouth touch and always looked lethargic with his head down whenever I visited his owner at the office.

As there was the possibility of deaths under general anaesthesia, the owner was not keen on my recommendation. More than one year ago, I had extracted 9 decayed teeth from Baxter under general anaesthesia but the bad breath had returned in 2008. Baxter is fed mainly home-cooked food. His coat condition is normal. His weight is normal and he exercised with his owner by jogging every morning around Mount Sophia area. Therefore hypothyroidism as a cause of his lethargy was ruled out.

Aug 9 08. National Day, Singapore
Baxter At home
2 pm lst fit (Stesolid rectal tube with 5 mg diazepam gel given by owner) > 45 sec
10 pm 2nd fit (Stesolid rectal tube with 5 mg diazepam gel given by owner) > 45 sec

Aug 10 08. Sunday
Baxter At home
7am 3rd fit (toilet roll into mouth to prevent tongue biting). 8 am 4th fit
8.30 am 5th fit
10 am 6th fit
Shorter 15 sec. "Massage his shoulder and talk to him," the owner said. "Fits become shorter in duration when I massage him. I also stuffed thick towel into mouth to prevent tongue biting."

"Why didn't you give Baxter the rectal diazepam," I asked.
:
"I wanted to observe how often he gets fits."

Epilepsy - 7-year-old Miniature Bull Terrier
Aug 10, 08.
Baxter at Toa Payoh Vets at 2 pm

1518. Owner had given 2 rectal diazepam gels. Blood and urine taken for testing. Drip given IV.

1519. Owner accepted risk of his dog dying during anaesthesia. A very high-risk anaesthestic situation.

2.10 pm IV catheter inserted. Took blood samples. Took urine sample via catheter.
2.15 pm IV 5% dextrose saline 200 ml
3-4 pm General anaesthesia gas. Extracted 20 loose teeth.
6 pm 7th fit of <20 seconds

Aug 11, 08.
4 am 8th fit (rectal diazepam)
7 am 9th fit of <20 seconds
10 am 10th fit of <20 seconds
2 pm 11th fit (diazepam 15 mg IM).

1520. Cluster of seizures continued. Blood test of very high white cell count indicated a bacterial infection.
Aug 12, 08.
No fits
3 pm Jaws chattering (diazepam 15 mg slow IV drip).

1522. IV diazepam given on Aug 12, 08. No fits up to 8 pm Aug 13, 08 when he was discharged to a happy owner. Reviews and medication necessary for some time.
Aug 13, 08.
Gave orally phenobarb 30 mg x 1, Potassium Bromide 200 mg tablet x1 at 3pm, 9.30 pm on Aug 13 (at home). No fits. 8 pm Goes home.

Thur Aug 14, 2008
9 am Phoned owner. No fits overnight.
9.30 am. Owner gave orally phenobarb 30 mg x 1, Potassium Bromide 200 mg tablet x1.

1.30 pm I visited Baxter at owner's office in downtown. Baxter quiet under the table. Sedation is a side effect of the drug. He moved up to go to the back room trying to get far away from me. He never bites me but he is never fond of me.

SIDE EFFECTS OF PHENOBARB:
Polyphagia. Owner said: "Dog is very hungry. Tried to topple the food container last night. Followed me everywhere." "Hunger is a side effect of medication," I advised.

Polydipsia and polyuria. Drinks a lot and passes a lot of urine.

Sedation: Depends on dose.

COMMENTS BY THE OWNER
Less lethargic. Owner remarked: "I notice that Baxter looks more alert and not so sleepy after extraction of his 20 loose teeth." This was despite phenobarb medication which causes drowsiness. I had noticed Baxter being very tired looking for past months and had a foul breath and did not permit anyone to touch his mouth.

Cause of epilepsy. Owner wants to know what is the cause of Baxter's epilepsy.
"The majority of causes of epilepsy in dogs are unknown and the epilepsy is termed idiopathic epilepsy," I said.
"Various causes of epilepsy include hereditary causes in dogs less than 5 years old but Baxter is 7 years old, damage to the brain by injury, toxins and diseases. In Baxter's case, total white cell count from blood sample revealed higher than normal. I believe it would be that Baxter's brain was infected. Encephalitis caused by bacteria leading to high fever and convulsions on National Day. The most obvious location of bacteria would be from the mouth. 20 loose teeth with exposed roots were infected and extracted. Also, the extreme pain in his mouth may finally aggravate his fits."

One of the tips of Baxter suffering from severe mouth pain when the owner said: "Baxter cries every day when he opens his mouth." Ms Tan, the 2nd year Victoria College student did mention it in her report which I asked her to write. She wrote, "The dog yelps in pain when it yawns, not surprising when you look at the state of its teeth."

I advised the owner to reduce dosage by half the amount from 9.30 pm on Aug 14, 2008 and wait and see if there are fits and let me know promptly.

It is best is to give the least dosage that is effective as dog gets hungry and sedated with phenobarb.
Will need to monitor closely. If the cause of the fits is the mouth bacteria and the brain damage is not lasting, it is possible that Baxter need not go onto anti-epileptic medication for life as he now has epilepsy with a cluster of 11 fits.

Only time will tell whether he can go off the medication. So far, the Gods have been kind to Baxter. I hope this hardy bull terrier would live a normal life going jogging with his owner soon.

I was really glad that he needs not suffer from a very painful mouth every day when he wakes up or yawns.

Dogs with idiopathic epilepsy can live a normal life if he is given anti-epileptic medication at the most effective least dosage and carefully monitored with blood tests and examinations.

Dogs with seizures with known causes removed will not have fits anymore.
A GOOD REPORT ON BAXTER FROM A LAYMAN'S POINT OF VIEW
WRITTEN BY MS TAN XINRU, A 2ND YEAR VICTORIA JUNIOR COLLEGE STUDENT SEEING PRACTICE AT TOA PAYOH VETS

Sunday August 10, 2008

A bull terrier was brought in later in the afternoon for a blood test. His stomach hurt when touched and could only be carried at the shoulders and hind legs. It had suffered from fits in May and had a relapse yesterday. The previous blood test at (the name of competiting vet practice) showed no anomalies. The fits last around 30-45 seconds and subsided when some medicine was inserted through the anus. It lasts 8 hours before the fits return again. His spine was prodded and the dog whined when the middle back was pressed, indicating pain, as when the stomach was pressed. Blood samples were taken (3 tubes) and sent to the lab. Two samples were taken to verify the consistency of the results. The dog yelps in pain when it yawns, not surprising when you look at the state of its teeth. Most were rotting away. The teeth were extracted as quickly as possible, gassing the dog at intervals to minimise the pain. The pain from the decaying teeth could be cause of the fits. A urine sample was also taken, which hinted at a problem in the kidneys. After the majority of his teeth were removed, the remaining were scaled. The dog was then put on a drip and left to rest. However, he had a fit about an hour later.

1521. Dog had much less painful mouth. 4 canine teeth & 1 molar teeth remained. 20 loose teeth extracted.
Ms Tan commenced her seeing practice recently as she intended to study veterinary medicine and surgery after her A levels.

All interns at Toa Payoh Vets are required to write their observations if they want to see practice at Toa Payoh Vets as writing sharpens their observations and make veterinary medicine and surgery alive to them.

Thursday, August 14, 2008
9. Epilepsy in a 7-year-old Miniature Bull Terrier (draft blog)
Epilepsy - 7-year-old Miniature Bull Terrier

May 14, 08. One fit. I asked the owner to consult the competition as it would be good for the owner and Baxter to get a different first opinion. Causes of fits in the older dog are notoriously difficult to find out.

The vet said that there was nothing abnormal in Baxter's blood test and examination. The vet prescribed phenobarb 30 mg and advised 2.5 tablets 2 times per day for 2 weeks. The owner was told that Baxter would need the drug for life. Baxter did not complete the 2 week of medication. As to the cause of this fit, it was not possible to pin point. The owner had antibiotics given. I advised dental examination under general anaesthesia some months before and even after the first fit to remove bacteria multiplying in Baxter's mouth. Baxter had objected to any mouth touch and always looked lethargic with his head down whenever I visited his owner at the office.

As there was the possibility of deaths under general anaesthesia, the owner was not keen on my recommendation. More than one year ago, I had extracted 9 decayed teeth from Baxter under general anaesthesia but the bad breath had returned in 2008. Baxter is fed mainly home-cooked food. His coat condition is normal. His weight is normal and he exercised with his owner by jogging every morning around Mount Sophia area. Therefore hypothyroidism as a cause of his lethargy was ruled out.

Aug 9 08. National Day, Singapore
Baxter At home
2 pm lst fit (Stesolid rectal tube with 5 mg diazepam gel given by owner) > 45 sec
10 pm 2nd fit (Stesolid rectal tube with 5 mg diazepam gel given by owner) > 45 sec

Aug 10 08. Sunday
Baxter At home
7am 3rd fit (toilet roll into mouth to prevent tongue biting). 8 am 4th fit
8.30 am 5th fit
10 am 6th fit
Shorter 15 sec. "Massage his shoulder and talk to him," the owner said. "Fits become shorter in duration when I massage him. I also stuffed thick towel into mouth to prevent tongue biting."

"Why didn't you give Baxter the rectal diazepam," I asked.
:
"I wanted to observe how often he gets fits."

Epilepsy - 7-year-old Miniature Bull Terrier
Aug 10, 08.
Baxter at Toa Payoh Vets at 2 pm

1518. Owner had given 2 rectal diazepam gels. Blood and urine taken for testing. Drip given IV.

1519. Owner accepted risk of his dog dying during anaesthesia. A very high-risk anaesthestic situation.

2.10 pm IV catheter inserted. Took blood samples. Took urine sample via catheter.
2.15 pm IV 5% dextrose saline 200 ml
3-4 pm General anaesthesia gas. Extracted 20 loose teeth.
6 pm 7th fit of <20 seconds

Aug 11, 08.
4 am 8th fit (rectal diazepam)
7 am 9th fit of <20 seconds
10 am 10th fit of <20 seconds
2 pm 11th fit (diazepam 15 mg IM).

1520. Cluster of seizures continued. Blood test of very high white cell count indicated a bacterial infection.
Aug 12, 08.
No fits
3 pm Jaws chattering (diazepam 15 mg slow IV drip).

1522. IV diazepam given on Aug 12, 08. No fits up to 8 pm Aug 13, 08 when he was discharged to a happy owner. Reviews and medication necessary for some time.
Aug 13, 08.
Gave orally phenobarb 30 mg x 1, Potassium Bromide 200 mg tablet x1 at 3pm, 9.30 pm on Aug 13 (at home). No fits. 8 pm Goes home.

Thur Aug 14, 2008
9 am Phoned owner. No fits overnight.
9.30 am. Owner gave orally phenobarb 30 mg x 1, Potassium Bromide 200 mg tablet x1.

1.30 pm I visited Baxter at owner's office in downtown. Baxter quiet under the table. Sedation is a side effect of the drug. He moved up to go to the back room trying to get far away from me. He never bites me but he is never fond of me.

SIDE EFFECTS OF PHENOBARB:
Polyphagia. Owner said: "Dog is very hungry. Tried to topple the food container last night. Followed me everywhere." "Hunger is a side effect of medication," I advised.

Polydipsia and polyuria. Drinks a lot and passes a lot of urine.

Sedation: Depends on dose.

COMMENTS BY THE OWNER
Less lethargic. Owner remarked: "I notice that Baxter looks more alert and not so sleepy after extraction of his 20 loose teeth." This was despite phenobarb medication which causes drowsiness. I had noticed Baxter being very tired looking for past months and had a foul breath and did not permit anyone to touch his mouth.

Cause of epilepsy. Owner wants to know what is the cause of Baxter's epilepsy.
"The majority of causes of epilepsy in dogs are unknown and the epilepsy is termed idiopathic epilepsy," I said.
"Various causes of epilepsy include hereditary causes in dogs less than 5 years old but Baxter is 7 years old, damage to the brain by injury, toxins and diseases. In Baxter's case, total white cell count from blood sample revealed higher than normal. I believe it would be that Baxter's brain was infected. Encephalitis caused by bacteria leading to high fever and convulsions on National Day. The most obvious location of bacteria would be from the mouth. 20 loose teeth with exposed roots were infected and extracted. Also, the extreme pain in his mouth may finally aggravate his fits."

One of the tips of Baxter suffering from severe mouth pain when the owner said: "Baxter cries every day when he opens his mouth." Ms Tan, the 2nd year Victoria College student did mention it in her report which I asked her to write. She wrote, "The dog yelps in pain when it yawns, not surprising when you look at the state of its teeth."

I advised the owner to reduce dosage by half the amount from 9.30 pm on Aug 14, 2008 and wait and see if there are fits and let me know promptly.

It is best is to give the least dosage that is effective as dog gets hungry and sedated with phenobarb.
Will need to monitor closely. If the cause of the fits is the mouth bacteria and the brain damage is not lasting, it is possible that Baxter need not go onto anti-epileptic medication for life as he now has epilepsy with a cluster of 11 fits.

Only time will tell whether he can go off the medication. So far, the Gods have been kind to Baxter. I hope this hardy bull terrier would live a normal life going jogging with his owner soon.

I was really glad that he needs not suffer from a very painful mouth every day when he wakes up or yawns.

Dogs with idiopathic epilepsy can live a normal life if he is given anti-epileptic medication at the most effective least dosage and carefully monitored with blood tests and examinations.

Dogs with seizures with known causes removed will not have fits anymore.
A GOOD REPORT ON BAXTER FROM A LAYMAN'S POINT OF VIEW
WRITTEN BY MS TAN XINRU, A 2ND YEAR VICTORIA JUNIOR COLLEGE STUDENT SEEING PRACTICE AT TOA PAYOH VETS

Sunday August 10, 2008

A bull terrier was brought in later in the afternoon for a blood test. His stomach hurt when touched and could only be carried at the shoulders and hind legs. It had suffered from fits in May and had a relapse yesterday. The previous blood test at (the name of competiting vet practice) showed no anomalies. The fits last around 30-45 seconds and subsided when some medicine was inserted through the anus. It lasts 8 hours before the fits return again. His spine was prodded and the dog whined when the middle back was pressed, indicating pain, as when the stomach was pressed. Blood samples were taken (3 tubes) and sent to the lab. Two samples were taken to verify the consistency of the results. The dog yelps in pain when it yawns, not surprising when you look at the state of its teeth. Most were rotting away. The teeth were extracted as quickly as possible, gassing the dog at intervals to minimise the pain. The pain from the decaying teeth could be cause of the fits. A urine sample was also taken, which hinted at a problem in the kidneys. After the majority of his teeth were removed, the remaining were scaled. The dog was then put on a drip and left to rest. However, he had a fit about an hour later.

1521. Dog had much less painful mouth. 4 canine teeth & 1 molar teeth remained. 20 loose teeth extracted.
Ms Tan commenced her seeing practice recently as she intended to study veterinary medicine and surgery after her A levels.

All interns at Toa Payoh Vets are required to write their observations if they want to see practice at Toa Payoh Vets as writing sharpens their observations and make veterinary medicine and surgery alive to them.

Updates are at www.toapayohvets.com
Toa Payoh Vets - Dogs - Epilepsy
http://www.bekindtopets.com/dogs/20080823Epilepsy_Miniature_Bull_Terrier_Singapore_ToaPayohVets.htm

8. How Your Senior Dog Can Live Longer?

2008-08-05T12:38:00.000-07:00

Most pet owners in Singapore live hectic lives. After an intense care for their puppies, the senior dogs are just left alone as there is no time for them after their puppyhood. It is usually too late for many dogs when they are sent to the veterinarian for some chronic disease problems. Veterinary costs become high as the dog is in poor health.

Senior dogs are:
Small and Medium-sized breeds: Over 7 years
Large and Giant-sized breeds: Over 5 years.

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

1. Veterinary examination every 6 months.
2. Blood tests to check for diabetes,liver and kidney diseases.
3. Urine tests to check on bladder and kidney infections and presence of stones.
4. X-rays if necessary for arthritic hip joints.
5. Dental check up and scaling every 1 year.
6. Heart check for murmurs.
7. Vaccination booster every year.
8. A discussion about the delay in senility, obesity, behavioural problems, skin problems and any questions related to each individual dog.

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

Make an appointment with your pet shop groomer if you have a close working relationship with them and needs pet transport. Or tel 6254-3326, 9668-6469 for an appointment.

7. Chronic urinary tract infection in a pug

2008-07-21T15:12:00.000-07:00

July 20, 2008 was a bright sunshine Sunday. It was an unusual Sunday in that my first 2 cases were pugs. Pugs are uncommon in Singapore as they went out of favour some years ago and so, getting two cases in a row was as hard a winning the 4-digit lottery.

Case 2 was a young pup that came in for a 3rd vaccination as a free vaccination was included in its sale by a pet shop. "How did you locate the surgery?" I asked the Caucasian expatriate as my surgery is difficult to locate even by the locals. The expatriate smiled and explained to the country pumpkin, "I use the GPS in my car. I key in Toa Payoh Vets and there was a map. Only that there was no address shown." I was impressed.

"How much does it cost to install the Global Positioning System in your car?" I thought I could do with one too if I do house-calls.

"About $400," he said. The expatriate certainly knew how to use technology to make life easier.

Now, back to Case 1 which was a highly emotional case for the lady owner as her pug passed clots and blobs of tissue with blood in the urine. The vet had prescribed antibiotics in higher doses and initially the pug's urine was clear. Then the pug started passing bloody tissues and she consulted me since I was the one who delivered the pug by Caesarean section according to the seller of the pug.

When antibiotics do not work in a urinary tract infection in the dog, the lady owner is often stressed. Having to clean up the apartment and the pug and then more cleaning, I guess. More bleeding. More cleaning. It is hard to imagine if one is a man who does no house work or not involved in the daily grooming of the dog.

Seven days ago on July 13, 2008

The lady owner saw me 7 days ago and today was the follow up. Seven days ago, she and her husband consulted me. She said, "As you do not spay dogs on a Sunday, I got the pug done at Vet 1. Maybe she was not properly spayed?"

"Vet 1 is a very experienced vet. He had done a good job. The pug does not have any heat now," I explained. "The bloody tissues in the urine come from the inside of the bladder. There may be urinary sand or stone irritating the bladder. The dog become incontinent, leaks her vulval area and cause bacterial infection into the bladder from her licking of the vulva."

"I consulted Vet 2 two weeks ago as my pug was passing blood in the urine. He gave a higher dose of antibiotics so as to kill all the bacteria inside the bladder. After the antibiotics, the pug passed pieces of tissues with blood."

This would be a very difficult case to handle as the lady did not follow up with Vet 2. What she wanted was to get the pug to stop passing bloody tissues during urination. There was no urine sample. I palpated the bladder and it was half full and firm, around 4 cm in diameter. There was no feeling of crepitus - a feeling of squeezing gas inside the bladder filled with small stones.

The collection of a clean urine sample from a female dog is not easy for Singaporeans. This lady was stressed out and so I did not insist on doing it. I gave the pug a different type of antibiotics and injections to relieve the pain and asked the lady to phone me in 3 days and to review in 7 days' time.

On July 17, the lady phoned me to say that the pug was no longer passing blood in the urine. She sounded happy. But I know the treatment of urinary tract infection in the spayed female pug is not easy. Follow up reviews are necessary and time-pressed owners just have no time usually. What they want is a permanent cure.

On July 20, the lady and her husband came.
"The pug can jump in the past 2 days," the wife said. Now, I did not know that the pug was not able to jump as I did not ask and she did not say during the July 13 consultation. Jumping or not had nothing to do with urinary tract infection, one would not ask such question.

But actually, this feedback is important. This indicated that the pug had sprained her back due to continual licking of her vulva due to incontinence. The pain and the itch and the sprain of the muscles must have restricted her active jumping for joy in greeting the lady owner.

If we turned the pug upside down, I could show the lady that the pug had vulval pruritus. The vulval lips were very small as the lady must have spayed the pug very young so that they had no female hormones to develop to adult size. The lady could not remember when she had the pug spayed. Now, continual licking caused the vulval area to be very black.

"Did you wash the vulval area during bathing?" I asked. "It is very dirty and becomes itchy. The black skin is caused by the pug licking this area for several months. Then trauma and bacteria infection go into the bladder through this long licking habit."

"I do not do it. I cannot restrain the pug alone." The husband said he would help out.

I sat on the chair and palpated the standing pug's bladder with my left hand. The bladder was full of urine. This was already 10.30 a.m.

"Did the pug pass urine after waking up?" I asked.

"This pug has a very bad habit. Always holding her urine for a long time. She will leak the urine a bit but will not pass urine regularly."

I said, "Most likely she felt pain when trying to pass urine. She passed a bit. I was painful. She stopped passing. So she hold her urine till the bladder becomes very full. Bladder stones form when the urine is not passed out regularly."

Is this a plausible explanation to the owners? If only pugs could talk.

"Is she leaking urine many times a day?" I asked.

"Not in the last 2 days," the lady said. Now there was urinary incontinence as well as urinary retention. What type of urinary incontinence is this pug suffering from?
There are a few classifications of urinary incontinence in veterinary medicine. I narrow down to two classes - paradoxical incontinence and hormone-related incontinence. Was the pug suffering from one or both?

Hormone-related incontinence happens to spayed dogs. Once the hormones are removed during spay or neuter, some dogs in the older age can't control their bladder. Replacement hormones help to solve this problem.

Now what is paradoxical incontinence? Is this pug suffering from paradoxical incontinence? In this situation, she might have bladder sand or small stones obstructing the urethra. So she could not urinate regularly until the obstruction is cleared. She leaked some urine. When the obstruction is cleared by the passage of the sand or small stones, she could pass out all the urine at one go, as had happened when she was outside the surgery for around one hour. That was how I managed to use the dipstick (picture) to test for blood in the urine.

After the pug had urinated, I palpated her bladder. Her bladder was now very small, around 3.5 cm in diameter. The bladder wall felt thickened. There were no single large stone, so I asked the owner to wait for 2 weeks.

It would be good to X-ray the bladder but it costs the owner money. The X-ray ought to be done with air pumped into the bladder and this involved extra cost. Urinary tract infection treatment require several consultations and the vet cost can shoot up.

Blood tests ought to be done too but they must be useful to the owner as the costs add up again.

So, in the meantime, I advised the owner to switch to a prescription diet which may dissolve the fine bladder sand. Pugs as a breed are not known to suffer from urinary stones, unlike the Miniature Schnauzer, Lhasa Apso, Dalmatians, Poodles and the Bischon Frise.

It is possible that the pug had very itchy vulva after spay. She licked the area till it became black and dirty. Bacteria went into the vagina and the urethra into the bladder over the past 3 years. Bladder became chronic cystitis. By the 3rd year, blood in the urine and then bloody tissues in the urine as the bacteria had accumulated without the owner being aware of the problem.

A clue from the lady was that the pug was "naughty and would always control her urine till her bladder was full and she would pass out a lot of urine."

Many of the urinary incontinent cases needed reviews and many Singapore owners just do not have the time or inclination to do it. In this case, a few follow ups may be necessary. This pug had been licking her front paws till they became black.

Coincidentally, 2 weeks ago, the Seller came with her pugs for the annual vaccination after receiving a vaccination reminder card from me. Her pugs had black crocodile-skin front legs like this pug.

So there seemed to be a connection somewhere from parents to progeny. If the vet can find a solution to control this pruritus - of the fore limb or vulva - the vet will be considered a "competent" vet by the owner!

The pug will be reviewed for a few times if the owners want to.

The lady was persuaded to collect urine for examination 2 weeks later and I gave her a bottle to do it. Thorough cleaning of the vulval area and wearing of the e-collar for at least 1 month.

A prescription Hill's Science diet will be fed for 1-2 months to dissolve the bladder sand which may be present. Only in 2-3 months will we know the result of the proposed treatment.

Many owners want a one treatment cure all but this is not possible in many cases of chronic urinary tract infection in a female spayed dog.

FOR VET STUDENTS:
http://courses.vetmed.wsu.edu/vm552/urogenital/micturit.htm
is a very good report on urinary problems in the dog.

6. Chronic idiopathic thrombocytopenic purpura in an old dog

2008-07-11T16:54:00.000-07:00

DRAFT

On July 9, 2008, I was attending a breakfast Oracle Seminar on "Innovation in Asia" at St Regis Hotel. My phone vibrated.

The owner phoned me at 9 a.m to say that his 11-year-old Silkie Terrier passed away in his sleep. His dog just stopped eating for 2 days and he had told me yesterday. The dog had grown hairs and was free of ear pain after my vertical canal ablation surgery in March 2008.

So we thought he would live for some years. Then in June 2008, the dog injured his left foreleg's toe.

The owner tried to treat it himself but the dog just gnaw at his toe till it became much swollen. He had to be operated under general anaesthesia again. I prefer not to operate an old dog a 2nd time. He survived the first general anaesthesia for his ear canal removal and it is better not to take the risk again as old dogs are high risk patients. This was 11 years old and he has reached the limit of his life span.

Now, this dog has a blood clotting disorder. His blood just does not clot easily during surgery. I did not do a blood platelet test to confirm that he had a low platelet count to save on costs for the owner. There is no cure for the idiopathic thromobocytopenic purpura. Idiopathic means that the cause is unknown although it is believed that the body makes antibodies to destroy its own platelet.

This dog would be suffering from a chronic idiopathic thromobocytopenic purpura and like the disease in people, he could live to an old age.

He had a left severe ear pain. Hard as a rock - that's what his left ear vertical canal felt to me. The cure was removal of this vertical canal, a surgery called vertical canal ablation. Now, would he die under general anaesthesia - being aged and thin? At the time of surgery, I did not suspect he had chronic idiopathic thromobocytopenic purpura. In retrospect, some blackish bruises on his bald body could be a tell-tale sign but old dogs may have such blemishes.

In any event, he survived the ear and toe amputation surgeries under general anaesthesia. He lived the last few months of his life without pain in his left ear and for that the owner was very happy that the dog passed away peacefully. I only talked to the owner by phone and had never met him as he is a busy person.

Tentative diagnosis of chronic idiopathic thromobocytopenic purpura in this case:
1. blood does not clot in the ear canal before vertical canal ablation surgery (see pictures).
2. a large haematoma after surgery (swelling above his left parotid salivary gland and where the vertical ear canal was removed, under the healed wound). At the toe amputation surgery, I checked the left facial swelling which was painful if palpated. It was just blood that did not clot. It was around 30 ml of liquid blood.
3. some purplish blood when the bandage wrapping the toe area is removed (see picture).
4. bruises in his body.

The dog was an extremely high anaesthetic risk and yet he survived 2 anaesthesias. Gas anaesthesia at the lowest dose was given. Intubation was done. No tranquilisers or pre-anaesthetic medication was used. No problems encountered during the anaesthesia although this was an old dog nearing the end of his life span. Pain-killers given for 7 days after surgery.

http://www.bekindtopets.com/animals/tpvets_May1308.htm
showed my first meeting with this gentle dog. I thought he was a hairless Chinese crested dog cross bred as he had not much hair. I was glad that the owner did not rush to put him to sleep on March 31, 2008. His wife was against euthanasia and well, this dog spent his last 4 months having a good time with the owner. We just did not expect him to pass away so soon as we got to know him more and his hair was growing back. He looked younger and handsome as his golden Silkie Terrier hair grew luxuriantly in his face and I thought he was rejunvenated. So his early passing away saddened me too.

"The dog is nearing the end of his life span," I said. "He h

DETAILED REPORT TO BE WRITTEN LATER.

5. Pyometra in a 4-year-old Lhasa Apso that eats to live

2008-07-02T14:13:00.000-07:00

The female Lhasa Apso had sticky vaginal discharge for some time. She was very thin and had a poor appetite for some months.

The owners went to Vet 1 near midnight. The owner did not want blood tests, X-rays or the immediate surgery advised. They had spent some money earlier for a severe diarrhoea treatment of the dog. Veterinary costs can add up when there is prolonged illness requiring many treatments and the family needed to reduce costs.

In this case, it would be prudent not to rush into immediate surgery as the risks of the female dog dying on the operating table would be very high. The challenge is when to commence the removal of the infected womb so that the dog would not die? Give antibiotics and fluid therapy for at least one day and check the rectal temperature to get better odds.

In this case, the dog survived the surgery after around 2 days of treatment. Although I gave her at less than 30% chances of survival, she surprised me. When the vet deems the ill dog a poor anaesthetic risk, the dog would many times prove the vet wrong.

In this case, the family of parents and 2 children came to the surgery and hand-feed the dog 2 hourly for the 2 days before surgery. Feeding 2 hourly after surgery was also essential post-op care. The dog lived.

This dog seemed to be the type that would eat to live, not live to eat.

Yet in Case 3, the other Lhasa Apso with pyometra that I would operate on Friday July 4, 2008 was so much different.

The other Lhasa Apso would be 9 years old and lived to eat. She was trim but not thin. "Always asking for more food," the owner said.

She was given antibiotics for some 7-10 days before surgery. She had very little sticky vaginal discharge as the owner was told to make her wear pads so as to collect some evidence of pyometra - pus in the womb. What would her chances of survival on the operating table?

I assess as more than 50% as the dog was active, trim and eating well. No vomiting. But pyometra had been there for some months as the dog had licked off the vaginal discharge without the owner's knowlege. 2 very small breast tumours had formed. No vet can guarantee 100% survival and this is where early discovery of pyometra or early age spay of the female dog would be preferred. Pyometra can be very stressful for some lady owners, causing sleepless nights prior to surgery.

4. Pyometra in a toxaemic Golden Retriever

2008-06-29T15:00:00.000-07:00

"Flies just would not go away when I swat them," the 65-year-old grandmother with a fair 5-year-old grandson came to the surgery. She was surprised at the tenacity of flies: "They just swarm onto the dog's vaginal discharge."

This was not good news. Flies are attracted to decaying flesh as moths are to candle light. Kamikaze flies who just cannot resist necrotic flesh.

The 12-year-old Golden Retriever had some vaginal discharge 2 months ago. The grandmother attributed it to the dog having heat. In the last 4 days, the dog passed out thick glue-like mucus from her vagina. She stopped eating for 2 days and had vomited.

"Your dog had a severe womb infection. She vomited because toxins could have damaged her kidneys and internal organs, " I did not give much hope of survival for this dog. "Why didn't you spay the dog after the breast tumour operation?"

My past procedure was to remove the breast tumour first and then spay the female dog later. In this way, hormones feeding any new breast tumour would not be available after removal of the ovaries.

The slim and fair grandmother laughed: "You said that XXX would not survive 9 months as her cancer could have spread to her body. Can you recall? breast cancer was as large as a tennis ball!"

I checked my records. It was September 2005 when the large breast tumour was removed. It was a solitary gigantic lump as large as a tennis ball. Now, in Jun 2008, the dog had a long scar where the tumour was. There was a small breast tumour around 2 cm in diameter.

My 'prediction' of 9 months' of life for this Golden Retriever had been way off the mark. It was now 33 months after tumour removal. Why would I give a definite 9 months, I cannot remember. Why not 3 months or any other number? No vet can foresee the future. But I did not argue as the grandmother had a sharp memory.

Now the dog was very sick. She had fever of 40.5 degrees C. She was not eating. She yelled in protest of great pain on the operating table when I stretched her legs to see the long 15-cm scar of the tennis-ball-sized breast lump.

She was now in poor health. If flies just zeroed into her vaginal discharge, it indicated that her womb tissues had rotted. Flies are suicidal and sticky when the tissues and discharges stink a lot. They seem to appear from nowhere and are large bodies flies from the vegetation near the house.

The grandmother understood the big risk of dying on the operating table. I boarded the dog one day to give her antibiotics, anti-fever and drips. The dog felt good 24 hours later and ate a full meal after canned food was added.

Now I had to decide. To operate 36 hours after admission or wait another day? The infected womb might rupture anytime as it was decaying. Her temperature had dropped to 37.5 degrees C, one degree below normal. She was sleepy and lethargic. This was a life and death situation. If the surgery was delayed another day, she would die due to toxic blood infusing her whole body. If the surgery was performed, she might die on the operating table as chances of survival were deemed below 50%. So, which decision to make?

The dog was given just gas anaesthesia and intubated. Her large thin-walled uterus and ovaries were removed. The reddish brown pus was copious. Bacterial toxins had seeped into the blood system by permeating past the uterine walls. The uterine horns were purplish in colour when the normal ones would be light pink.

The dog survived the surgery. After waking up, she vomited a big mass of food on the operating table. I had taken out the endotracheal tube some 2 minutes ago.

This was an abnormal event as she had been starved >12 hours prior to surgery and should not vomit anything. This indicated that the stomach was not moving the food along the gut. Another abnormal feature was the dark bluish black blood of her omental blood vessels. Normally they would be reddish.

Such negative signs were not good for the dog. I phoned the grandmother to come to see the dog after surgery which was completed around 11 am. I assessed that this dog would not survive and it would be good for the grandmother to see her. She was the dog that brought newspapers to the grandmother every morning and kept her company. However the grandmother's two adult sons needed her at the airport - one going abroad and one returning to Singapore.

At 7 p.m, the Golden Retriever just passed away quietly due to heart failure. Her gums and tongue were cyanotic. We informed the grandmother. She came around midnight.

5 days later, the grandmother came to pay the bills. "My daughter said there would be nobody in your surgery during lunch-time," grandmother said. "But there ought to be somebody."

Grandmother was correct. I had just returned from visiting abalone farms in Xiamen, China.

Grandmother was sad in her heart. Every dog's death is saddness for everyone involved. I asked grandmother to sit down and we reminisced in the consultation room. Just to know more about XXX.

Grandmother said, "XXX dog behaved strangely the night before going to the vet. She dog walked around the house and went to the back garden to stroll by herself."

"Does XXX not wander around usually?" I asked as the bungalow would have ample garden for her to roam.

"No," grandmother said. "XXX does not go to the back garden by herself at night."
"She also went to my daughter's bedroom to sit and wait patiently."

"Why would she do it?" I asked.

"She waited till my daughter gave her a second piece of Pokey biscuit. My daughter said to her 'You are permitted only one Pokey biscuit. Go away. Mommy will scold me'" the daughter told XXX off.

"But XXX would not go away. My daughter gave her a second Pokey biscuit stick and after eating it, XXX left."

Was the dog saying good-bye to the family members and the house? It is hard to explain such behaviour. Some animals might know that their life would be ending soon and wanted to say good-bye.

Grandmother stoically said to me: "My grandson keeps asking when Jesus will bring XXX back." The 5-year-old was too young to understand that death was permanent.

Would spaying her when she was younger prevent pyometra and prolong her life? Without the womb, she would not have pyometra and therefore would live to a ripe old age of another year or two? It is hard to say. Anaesthesia in dogs older than 8 years are high risk.

No vet can be assured of 100% survival in such cases. Sometimes it is best to pass such high risk cases to other vets. The daughter still grieved her loss daily for the past 5 ddays. "I guess she would be angry with me," I said to the grandmother. No comment from her.

Grandmother was stoic. Her friend had just got a stroke. She was widowed some 2 years ago and had now fortified herself.

"This dog was adopted as a puppy when there was a newspaper advertisement in the Straits Times looking for homes for the puppies to be given free," grandmother recalled. "I saw the advertisement when the newspapers were delivered at 5 am. Usually papers come at 7 am. So I went with my two sons and the owner gave us XXX. XXX used to bring the newspapers into the house every morning."

Grandmother had lots of work to do with so many dogs and children. "At one time, I looked after 8 dogs. Friends asked me to care for them for a while. They just did not come back for the dogs. I have 3 children to cook for and look after."

What an active energetic life, grandmother must have had. Though she was now 65 years of age, she looked much younger and trimmer than a 50-year-old. Usually grandmothers look matronly but she was a model for the slimming saloons.

"I cured one terrapin with enlarged closed eyes just by researching the internet," the grandmother said to me. That was great news. Most Singapore women of her age would not touch the computer.

"I can remember important dates and do calculations fast," the grandmother reminisced. "I would tell my children the price per kg for things they bought. But lately, I am not able to calculate so well."

It was good that she came during lunch time as we had some time to talk about the dog. "I can't stay long to chat," grandmother suddenly saw that time had passed so fast. "I have to go to Hong Kong,"

"Why do you have to rush to Hong Kong?" I appreciated the grandmother taking the trouble to pay the bills without being asked to do so.

"To look after my grandson for a week while my son and his wife had to go on holidays" she said. "There are two maids looking after him too."

All grandsons must surely love her very much but the one who loved her the most was the 5-year-old boy who stayed with her in Singapore. This 5-year-old boy came with the grandmother during the consultation and later around midnight to see the dog. A fair-looking boy with big eyes. He asked his grandmother for the past days with questions the grandmother told me, such as:

"Why Jesus take away XXX?"
"Why XXX has not come home?"
"Only one (pre-school) classmate knows when I said that XXX had gone to see Jesus."

The grandson had come with the grandmother during consultation as his pre-school had closed due to the presence of hand-foot-and-mouth disease prevalent in Singapore at this time.

It is extremely high risk to operate on toxaemic pyometra and old dogs. If the owner had returned to get the dog spayed one or two months after the breast tumour removal in 2005, this dog might still be alive. She might have died during the spay surgery too but the probability of her dying on the operating table when she was 10 years old would be much lower.

Singapore owners generally have not reached a high level of awareness stage that the dog must be spayed after removal of the breast tumour. They just forget about the spay once the tumour is removed. It is not prudent to remove the breast tumour and spay at the same time in old dogs as the prolonged anaesthetic time increases the risk of death on the operating table.

My present procedure would be to spay the dog first. If the owner did not return to get the breast tumour removed 2-4 weeks later, the female hormones feeding and growing the tumour would be removed as the ovaries would be taken out during the spay. Ideally, spay and mammary tumour removal should be done at the same time. But the surgery would take a long time and at the end of the long surgery, the dog might die on the operating table.

No family member can forgive or forget a death on the operating table. So it is best not to take foolish risks.

3. Pyometra in old female dogs - To spay or not to spay? Is there a choice?

2008-06-28T01:55:00.001-07:00

DRAFT - CYSTITIS + PYOMETRA IN AN OLD DOG

From: ...@singnet.com.sg>
Subject: Question re Dog Licking Herself More Often
To: drsing@toapayohvets.com
Date: Tuesday, June 24, 2008, 6:31 AM

Hi Dr. Sing,

It has been a while since we last corresponded.

Can I please get your advice as my dog XXX has been licking her private parts
more often recently? There's no discharge on the floor, and she's
eating per normal and active as usual. Normal urine and poo too. However when I
check inside her vulva, I see a clear discharge. It isn't much and
doesn't ooze or drip out of her body too.

Her vulva is not swollen or red; it is just normal in colour with one or 2
faint tinges of pink. When I check, her vulva feels soft to the touch, but the
part right after that, i.e. the area between the vulva and the anus, feels
firm/hard to the touch. Is that normal? NO

Is
there anything I should worry about? FYI, XXX is 9 years old and unspayed.

Could her licking be related to the possibility of her coming into heat soon?

My dog's last heat was in Feb 8 through 25. The one before that was in Sept
23 through Oct 11. It was 5 months or 20 weeks between last year's heat and
the most recent one in Feb. Do you think my dog is going on heat again soon?

When does a female dog start licking herself before her season? 2 weeks before
or?

Please advise. Thanks very much!

Best regards,
Name given

E-MAIL REPLY JUNE 24, 2008
Re: Question re Dog Licking Herself More Often - PYOMETRA
Tuesday, June 24, 2008 9:20 PM
From:
"David Sing"
View contact details
To:
...@singnet.com.sg
Cc:
drsing_98@yahoo.com

Most likely on-line diagnosis (which is not recommended or advised) is that your dog is suffering from open pyometra. In this condition, the womb of the old dog has been infected by bacteria. Large amounts of pus are produced inside the uterine tubes.

Toxins from the bacteria get into the bloodstream to damage the kidneys and other organs. In time to come, the dog cannot cope with the licking away of the copious flow of vaginal discharge. The dog gets septicaemia and starts vomiting more and more often.

The only treatment of pyometra is surgery to remove the womb and ovaries (spay). Pyometra can be an emergency in many cases as many Singapore owners delay treatment thinking that the unspayed female dog is just having heat.

I just had a 12-year-old Golden Retriever with "heat" 2 months ago. (I presumed the dog licked her vaginal discharge so the owner did not see any more discharge). 2 weeks ago, sticky yellow vaginal discharge attracted flies which would not be swatted away. She vomited 2 days before surgery. Would not eat.

Depending on its health status, some dogs die before, during or after surgery. As many Singapore pet owners consider spay as "cruelty" but are uneducated as to what is pyometra, they often seek surgical treatment very late and the vet sometimes gets blamed for the death of the dog during or after surgery.

In your case, you have no choice but to see your vet and get a professional examination and opinion. It seems that your unspayed dog has been infected for some weeks. Female dogs spayed when they are young will not get pyometra for obvious reasons - they don't have the womb. There are pros and cons of spaying.

UPDATE ON JUNE 25, 2008
Dog seen on Jun 25, 2008

Active, eating. No fever. Bad teeth and infected gums.
No copious vaginal discharge. A dot of pus seen on tissue paper.
Had a urine test at another vet some time ago - protein ++ in urine.

Palpation of uterine horns: some swelling felt. Around 1 cm thick uterine horn.
Palpation of bladder. The dog "yelped" and hunched her back, indicating acute pain response at the area where the bladder and uterine horns are located. It was good that the owner saw the pain response.

Diagnosis: Pyometra and likely a bladder infection. Owner said the urine is clear.

Advice: Antibiotics for 10 - 20 days. Spay on around 10th day. Dental work around 60th day.
On Day 2 after consultation, owner said that the vulval swelling had subsided.

This is a case of early pyometra. As the owner is close to the dog, she noticed the dog's unusual behaviour of licking the vulva. As to chances of survival during or after spay operation, this dog has a 75% chance of survival after antibiotics for 10 days. No vet can guarantee 100% for any old dog under anaesthesia.

Blood tests and X-rays will add to veterinary costs but some owners may not want to incur high costs. Surgery and general anaesthesia at Toa Payoh Vets is around S$500 - $1,000.

E-MAIL ON JUN 29, 2008

From: ...@singnet.com.sg>
Subject: FW: Kong Yuen Sing sent you a message on Facebook
To: drsing_98@yahoo.com
Date: Sunday, June 29, 2008, 1:54 AM

Dear Dr. Sing,

Thanks so much for your
detailed replies to my questions as usual.

My dog seems to be much better after starting on the antibiotics. The redness
on the vulval/anal area has gone off a fair bit, and most importantly, she
has not been licking her vulva that much. I observe her very closely and I see
her licking her vulva only once or twice a day. So that means that the
antibiotics are working very well as they should now that it's Day 4 on the
antibiotics. I'm glad we listened to your advice to put her on the course
of antibiotics first before the surgery.

You mentioned that if "IF THE INFECTION HAD GONE AND THE WOMB IS BACK TO
ALMOST NORMAL SIZE, I CAN HOOK IT UP. INCISION WILL BE LIKE THE USUAL SPAY
INCISION. AROUND 1-1.5CM.

IT IS POSSIBLE THAT I CAN HOOK THE WOMB OUT IF IT REVERTS TO NORMAL SIZE AFTER
ANTIBIOTICS. IN SUCH SITUATIONS, THE BEST TIME TO SPAY HER IS 1 MONTH
LATER."

I thought a lot about what you said, but I don't think we can wait as my
dog's last heat was Feb 8 through 21, so she is due for her next heat very
soon, whether she has a 5-month or 6-month period in between cycles this time.
If she goes on heat again while we are waiting, then we will need to wait
another month or so. Moreover, she had a UTI or bladder infection after her
heat the last time, so I'm concerned she will get the same problem again if
we let her go on heat naturally.

I am planning to let her undergo surgery as scheduled this coming Friday 4
July. It will be Day 9 of the antibiotics.

Do I give her the antibiotics on Friday morning even though she has been
fasting since 8 PM on Thursday night?

Will you be able to tell from palpation of her uterus whether it has gone back
to almost normal size, before you start the surgery, and thus decide whether to
hook out the womb out (and have a smaller incision) or open her up
slightly more
(and have the 4 cm incision) ?

How much would your transport man charge for a one-way trip from your clinic to
my home in Woodlands St 82, if I can't pick her up myself?

Thanks & best regards,
XXX

E-MAIL REPLY JUN 30, 2008
To:
...@singnet.com.sg>

No antibiotics on day of surgery.

Not able to palpate the size of uterine horns in your dog if it is small due to recovery from bacterial infection.Will try to hook out first.

I believe the transport man (independent contractor) charges $50 but you can pick up your dog even late towards midnight as we have somebody around or let her rest till the next day. You need to phone us first.

1. Palpation for painful spots in a Shih Tzu

2008-06-15T14:01:00.000-07:00

The pain was killing him loudly when the 4-year-old Shih Tzu was at home but he was silent, looked normal and merely limped a bit on his left fore leg when he was brought to the Surgery. He did not put much weight on his left fore and therefore I assumed he had pain in his shoulder joint or somewhere in his left leg.

After observing him walking here and there in the 80 sq. ft consultation room now packed with 3 owners, myself and my assistant, there was little space for this little Shih Tzu to walk. But he walked and was as cool as a cucumber.

"Put him lying on his right side the examination table," I asked my assistant. The Shi Tzu did not struggle. When I flexed and extended all his joints from the paws to his shoulder a few times, he did not feel any pain and so he did not cry or move away.I abducted and adducted his shoulder joint. No pain. So, why was he limping so obviously to all? I pressed his paws and the rest of his leg. No pain at all.

"He kept crying and whimpering past midnight for some hours," Mum was stressed out by this incident and probably had no sleep. "He was OK the whole day and after dinner."

"No," the teenaged daughter contradicted. "He started whining for attention at 9 p.m" and then cried.

"He was crying as if in pain for the whole night," Dad said.

"Did you give him any medication or pain-killer?" I asked.

"We thought of giving him some pannadol but no, we did not."

The next stage of the examination would be palpation. I put the dog standing on the table and used my right hand to press his abdomen. Starting from the stomach area to his bladder usually. I asked the agitated Mum and the other 2 family members to listen to the reactions of the palpation for pain of this dog I had known since he was a puppy.

"Did you hear the "hiss" sound from the Shih Tzu?" I asked the family members. A slight hunching of the back and a soft hiss that could be easily missed when I palpated the stomach/pancreas area. A painful reaction that the family members missed as it was so quick and so soft.

There was something painful in this anterior abdomen.

I started the palpation a bit forward or cranial to the stomach, just below and midway near the rib cage. That would be the location of the liver and gall bladder. I pressed the fingers of my right hand together to where the gall bladder would be.
This time, the Shih Tzu grunted like an old man. Loud. Everybody could hear it. I did not reproduce the same pain reflex as that would not be good for the dog.

So, the cause of his pain was this gall bladder area. There was mild fever. Was the dog having gall bladder infection or gall bladder stones?

"What's the bright yellow discoloration of the front half of his white coat on his shoulder?" I asked. "Is it urine on his white collar?". I doubted it was urine as this dog was well cared for. This Shih Tzu had a full white collar.

"Maybe tumeric powder?" the father said. I guessed tumeric powder referred to the chilli powder used for making curry.

"What do you use to shampoo the dog?" I asked. Yellow shampoo can discolor the white coat.

"He applied some brownish tick powder to kill the ticks as the dog had lots of ticks," the mother said. "He got the powder back from India."

"Tick powder is very poisonous if licked by the small dog," I said. "It is possible that the liver and gall bladder could be affected, causing the pain."

Mum ticked off Dad for buying tick powder from India during his business travel. So the use of tick powder is now a prohibited substance in this dog as it might poison his liver when licked.

"Does the dog jump a lot?" I asked.

"He jumps from sofa to the floor and from one piece of furniture to the next," the daughter said.

"It is possible he could have had strained his left shoulder when he missed a step on landing," I referred to the dog's limping left fore. "He could have felt the pain yesterday but now he had recovered."

If only dogs can talk. There was a slight fever and therefore infection of the gall bladder could not be ruled out.

"We have a 5-month-old Shih Tzu who plays with him," the daughter said. "The new dog is a female and was bleeding being on heat, 5 days ago." I had presumed this dog was the sole pet in the house.

"Did he injure himself while trying to mate with the female?" Twists and turns as he would be inexperienced and the female dog was not receptive at this stage of her heat and so he injured himself, causing lots of pain to his anterior abdominal area. And at night when everybody wanted to sleep, the pain radiated out from the injured area near the gall bladder.

No family member was sure about his sexual activity. This was the first time they had a female dog who was also full of ticks. It is just possible that he was too vigorous in his pursuit of the female, slipping off when the female moved away and trying again. Climbing up and falling down, hurting his anterior abdomen. A sound hypothesis?

I got the Shih Tzu clipped bald to remove all ticks. He was all right when he went home. As for the gall bladder pain, no further blood tests or X-rays would be done for the time being. It would be good to do all the ancilliary tests to confirm the diagnosis of gall bladder/liver infection.

However, from the owner's point of view, the less costly the veterinary fees are, the more appreciative they are. If there is a relapse, blood tests and X-rays would be done. It had been 3 days and there was no complaint from the family. The dog was back to normal. Today is Sunday Jun 15, 2008. I hope he has a good father's day from his pretty teenaged daughter who might be studying to be a doctor or veterinarian.