Sunday, September 24, 2017

3149. Dr Sing Kong Yuen shares tip on how to make the minimal skin incision in spaying a dog

Many owners feel happier if they see a short skin incision in their dog after spay. There is key-hole spay surgery but it is expensive. Knowing the location and where to incise the skin can result in a less than 2-cm skin incision using a scalpel.

Video as follows:

3148. A dwarf hamster has a heavy painful ear tumour

The dwarf hamster passed bluish grey powdery stools for many weeks. Why?
The colour looked similar to the pelleted bedding. 
"Your hamster eats the pelleted litter too," I said to an incredulous owner. Why eat bedding when the hamster has lots of food provided. She was a voracious eater. She weighed 60 g on admission but had this watery diarrhoea.

I warded her at the clinic and her bedding was paper towels. Her long lower front teeth had curved inwards up the roof of the mouth. These teeth were clipped short. Oral antibiotics given.

The next day, her stools were light brownish watery diarrhoea. By 3rd day, the stools were dark brown and better formed. Lots of stool pellets seen. Hamster active. See video.

Surgery to remove ear tumour scheduled 2 days later.   

3149. A 4-week-old kitten gets ringworm from the dam.

Sep 25, 2017

Ringworm is contagious. The dam might have had been infected during clipping. The kitten gets infected from direct contact, nursing.









Treatment:
Start to wean kitten now. By 5th week, weaned. Anti-fungal wash and oral medication.

Tuesday, September 19, 2017

3147. n 11-year-old English Cocker Spaniel has a large tumour near the left jaw (submandibular tumour)

Sep 19, 2017

The dog came in for 2 days of diarrhoea. On physical examination, there was a large left submandibular tumour, bigger than a golf ball. It is lobulated. It was not present when we removed the left lower inside cheek tumour 5 months ago.  

BLOOD TEST
Only the urea and creatinine is below normal. Other values for liver and haematology are normal.


Monday, September 18, 2017

3146. INTERN A 4-week-old kitten has generalised ringworm

Sep 19, 2017

A 2-year-old cat had caesarean section 4 weeks ago. She was clipped before surgery.
Today, the owner came as the dam was shivering yesterday and had skin disease. The kitten was also having extensive skin disease.

VIDEO

Ringworm  is a fungal infection of the top layers of the skin and hair. The kinds of fungi that cause ringworm are called dermatophytes The most common dermatophyte in cats and dogs is called Microsporum canis.


Diagnosing Ringworm

1. Ultraviolet light to screen for ringworm. About half of M. canis cases will "glow" when exposed to its ultraviolet light.

2. Hair from the lesions, which is then examined microscopically.

3. Culture test that grows the ringworm fungus.
A sample from the lesion is placed in a special medium designed to grow ringworm. Needs 2 weeks to know the result.

CASE STUDY
4-week-old kitten has classic signs of ringworm, face and body as she suckles from the mum.
Dam's belly had ringworm. Contact.
Dam had shivering yesterday. Likely milk fever. Rectal temperature checked. 38.5 deg C, means no fever.

ADVICES
1. Separate kitten from mum now, to prevent milk fever stiffening of legs and muscle tremors due to insufficient blood calcium in the mum's blood.
2. Wean kitten on wet food and milk.
3. Treat ringworm for both for 24 days oral and wash.
4. Disinfect environment


Infected clippers
No ringworm seen under UVL if shampoo used

3145. Congenital diagraphmatic hernia in a 10-year-old Shih Tzu X





Compare to normal lungs and heart of a 5-month-old Yorkshire Terrier with complicated kennel cough below:

3144. 14-year-old large cross breed barks at 5 am

Sep 18, 2017

"I spent $1,200 veterinary fees in one day," the woman had his lame dog X-rayed by Vet 1 and Vet 2. "At the 2nd clinic, the vet gave some injection and a patch. Peaceful sleep for everyone."
"The dog will stop barking for around 4 days," I said. 
She nodded. "The neighbours complained to the police and the policemen visited me yesterday!"
She asked for a house-call to put the dog to sleep after 6 months of care-giving. Exhausted.
"There is the alternative of giving pain medication before sleeping," I advised. "You need to adjust the dosage to effect."

The owner came for the medication.  

3143. Blood test for health screening of the dogs older than 5 years. Case study of a bad breath 6-year-old Corgi. Fasting glucose level

The most common panel of screening lab tests for general, overall health status includes:
complete blood count (CBC), that tells us how many red and white blood cells a patient has.

differential, part of the CBC, which shows how many of each different type of white blood cell is present.

chemistry profile (chemistries), which conveys information on the major organs (liver, kidneys, pancreas), blood sugar and electrolytes (sodium, potassium, chloride, bicarbonate, calcium, phosphorous).




urinalysis, which has a chemical part (ph/acidity, concentration, protein, sugar, etc.) and a microscopic part (bacteria/infection, bladder cells, kidney cells, blood cells, crystals that might contribute to stone formation, etc.)


The above collection of tests is sometimes referred to as a “minimum database,” or the smallest collection of tests that will give us a good overview of a patient’s health. This panel might be requested for screening before anesthesia, or a pet ill with non-specific signs.

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CASE STUDY

Sep 17, 2017

Corgi, F, Not Spayed, 6 years old.

Sep 16, 2017
The owner just wanted a blood test to screen her health.
The dog has bad breath. He did not want dental work.
Blood test -

Glucose (Fasting ) 3.3  (3.9-6.0)
                                      (5.6 - 13.9) Vetsulin level for stable diabetic dog.
Low values for creatine  62   (89-177)
High Hb 21.2  (12-18), ALT  65 (less than 59)


Sep 17, 2017
Owner finally decided on dental as he had to board the dog with his friend. Bad breath was terrible.
Dom + Ket at 50% IV.  (50% of Dom 0.4 and Ket 0.5) quite effective. Isolflurane gas standby.
Only one loose tooth  RU Premolar1.

VIDEO




Sunday, September 17, 2017

3142. A rapid panting 10-year-old male neutered Shih Tzu pants non-stop today

X-rays show fluid in lungs. Vet 1 aspirated blood today from the chest and showed owner. Is the blood from the lung tumour or bleeding due to ruptured blood vessels?

CT scan would cost $3,500. The dog wa very week and panted rapidly.


X-rays 2 months ago by Vet 1


Is this a case of congenital diaphragmatic hernia?
 
Always sit with one back leg inwards since young instead of both hind legs straight. Body is curved since young.

BLOOD TEST
Sep 18, 2017. Low RBC, Hb and platelets. Very low platelet count. Auto-immune thrombocytopenia?

3141. INTERN. A dwarf hamster has rapid breathing - respiratory infection

"Blocked nose sounds," the owner said.





 Video of sounds

CONCLUSION
The vet needs a closer physical examination as the small nostrils are less than 2 mm across. Nasal plugs removed using cotton bud. Stethoscope onto the chest revealed harsh lung sounds.

Once the blocked nostrils were cleared, and oral medications were given for the past 2 days of in-patient treatment, much less nasal sounds were heard and the hamster could breathe easier and normally.
 

Antibiotics orally. Inpatient 2 days to enforce cage rest. Around 50% of the appetite returns. The owner wanted the hamster home.

In this case, the respiratory infections could be caused by bite wound infections from the other male sibling. The owner saw bleeding around the top of the neck area some days ago and wiped off the blood. The sibling got bitten but did not lose appetite or become lethargic.

It is best to house male dwarf hamsters over 3 months old in separate areas as many do bite for space inside the small caged area. . 

Saturday, September 16, 2017

3140. INTERN. Lifestyle of a male stray cat and kidney disease

Sep 14, 2017


HOOK

Animal shelters will put the stray dog or cat to sleep after a few days
No kill shelters do not put them to sleep. E.g. NANAS, Yangon Golden Heart  (images, videos)

Many younger Singaporeans care for the stray cats. Some will feed them and bring them to the vet when they are sick. Others will get them neutered or spayed and look for them to be adopted. Most of these feeders have no means to provide them a safe sanctuary of the home and so the cat roams freely and suffers the consequences of abuse, infections from fighting and live a shorter life.  



This educational video shows a case study of a free-roaming stray 5-year-old male cat with difficulty in passing urine seen at Toa Payoh Vets.

5-year-old, male cat, not neutered, fed but allowed to stray
Brings to Toa Payoh Vets when the cat is sick. Cat fights.Infected wounds.  

 
On Sep 14, 2017
Pus inside the urine seen. Dysuria (difficulty in passing urine.) No urethral obstruction.
Catherised under gas anaesthesia, being ferocious. Urine sent for analysis. Bladder irrigated.



VIDEO WITH INTERN.




X rays - Enlarged kidneys.
Pyelonephritis with pus in the urine catherised. X rays enlarged kidneys. No urinary stones.
blood test. chronic kidney disease. Increased urea, creatinine and low platelet count. No leucocytosis.


urine test.







Urinalysis
Slightly turbid yellow urine
pH 8 (5-8)
SG 1.026  (1.005 - 1.030)

Nitrite Negative
Protein 4+  (proteinuria)
Glucose Negative
Ketones 1+
Urobilinogen Normal
Bilirubin Negative
Blood 4+

Bacteria 1+
White blood cells  over 900 (/uL)
Red blood cells over 1800 (/uL)
Epithelial cells 40 (/uL)
Casts, crystals Nil


No owner. One couple feeds him outside the apartment.

Stray cat's lifestyle is freedom to roam.   Not neutered by feeder. Fights. Eye injuries some 8 months ago and treated at Toa Payoh Vets.

Kidney disease affects cats after 5 years of age. Male cats more affected than female cats.   Health screening by blood and urine test will be best to pick up early kidney disease in cats over 5 years.  

Friday, September 15, 2017

3139. Continuing education. Dr Melanie Hicks and Abaxis S E Asia lecture at Suntec City Sep 15, 2017

Sep 15, 2017
Useful updated lecture on chronic kidney disease and blood testing equipment.



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Updated on chronic kidney diseases in dogs and cats





Dear Dr Sing and team, 

This year, we Alfamedic is proud to present you the first Abaxis South East Asia Lecture Series to Singapore. Everyone is invited! :)

Abaxis brought you and team Dr Melanie Hicks, Senior Professional Services
Veterinarian for Abaxis Global Diagnostics. In the past four years, she has lectured in clinical pathology topics at numerous veterinary schools and technical colleges, and has provided hundreds of in-hospital seminars on topics in clinical
pathology and practice management. Dr Hicks has been a Director or her provincial veterinary medical association for eight years, acting as President for 2011-2012. She has served as a national Director for the Canadian Veterinary Medical Association for three years, currently sits on executive and will become the national President in 2019.

The details for this half-day event are as below,
Date - 15th September 2017 (Friday)
Time - 10am - 2pm (Registration starts 930am)
Venue - Suntec Convention Center, Room 300/301
Topics -
1. Histogram and blood film interpretation
2. Leveraging diagnostics in your practice
3. Managing chronic kidney disease




QUERIES ON LOW BLOOD UREA AND CREATININE IN A COCKER SPANIEL WITH SUBMANDIBULAR TUMOURS



Pertaining to your queries, Dr Hicks suggested that a patient with low BUN and creatinine is not due to kidney disease per se (generally both tend to be high, along with potential other abnormalities in phosphorus, USG, urine microalbum and UPC etc). 
 
Low creatinine can be caused by a reduced lean muscle mass (most common cause).
Low BUN can be due to hepatic dysfunction. 
 
Both can be due to medullary washout (psychogenic polydipsia, excessively high IV fluid rate). 
 
Generally a slightly low BUN & creatinine is not significant if the above have been ruled out.




3138. INTERN. NON-COMPLIANCE. A Siberian Husky licks its tumour till it inflames and bleeds








Sep 15, 2017

HOOK
Above images and short video clip of tumour close up. Narrate.
 
 

Tumours grow bigger every day. Friction with the floor. Traumatised. Inflamed. Infected. Licked.
Bleeding. Soil apartment. What to do now?


This case study shows the dog had licked the itchy tumour till it becomes inflamed red and bleeds, soiling the apartment. The owner had been advised to come for tumour surgery 3 months ago, after antibiotics and anti-inflammatory injections.

"We were too busy," the owner noted that the tumour had shrunkened a bit and was not inflamed in the June treatment. Now, the tumour is red and bleeding. She wanted immediate surgery.


 Title: Not complying with veterinary instructions


"In such cases of infection, the skin wound after the surgery is unlikely to heal," I said. "The nearby skin is inflamed and infected. This results in a large open wound and more expenses." The dog was sent home on antibiotics for 2 weeks before surgery.


VIDEO OF CONSULTATION AND HISTORY.


CONCLUSION
Infected tumours need their infection to be treated by antibiotics before surgery. This ensures that the surgical wound after tumour removal will heal well. Otherwise, there will be a large hole which is hard to heal.

This case shows that compliance with veterinary instructions is less expensive than repeat treatments.  




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Wednesday, September 13, 2017

INTERN An unusual case. A 5-month-old Yorkshire Terrier has "kennel cough" for over 2 months

Sep 14  2017

HOOK



The owner showed a video clip of her puppy coughing and coughing 2 months ago.




Coughing like an old man with lung disease after purchase from a pet shop in Singapore. Hacking cough. Dry cough. Nothing coughed up.
 

Uncomplicated cases recover around 14 days. Complicated case in this Yorkshire Terrier - seen Vet 1 two times and given antibiotics and anti-histamine in the past 2 months. Still coughing daily when seen at Toa Payoh Vets in Sep 13, 2017.



What cause this Yorkshire Terrier puppy to cough and be itchy for over 2 months?

This video discusses an uncommon case of a puppy suffering from dry coughing for more than 2 months.  
KENNEL COUGH RESPIRATORY DISEASE and SKIN DISEASE.


PART 1. KENNEL COUGH RESPIRATORY DISEASE.


PART 2. SKIN DISEASE
This sister referred this her sister to Toa Payoh Vets to get the itchy skin disease treated.








CONCLUSION

Many new puppy owners are not aware of the need to do a post-purchase veterinary examination of their puppies. Some reputable puppy sellers in Singapore do advise a 24-hour veterinary examination after purchase of the puppy to check its health.

This Yorkshire Terrier puppy was purchased at 3 months of age. She was coughing and had been scratching her whole body since purchase. The owner had consulted Vet 1 twice to cure her coughing. Vet 1 took X-rays and said there was no pneumonia. Anitbiotics and anti-histamines were prescribed, but the cough persisted for over 2 months. The owner  
.



X RAYS by Vet 1
Cloudy areas around the lungs and heart indicate inflammation and fluid accumulation. This is known as pleural effusion. The inflamed lungs not as black as in normal lungs.












Auscultation at Toa Payoh Vets. No acute pneumonia. The following tests were done to assess the health of the puppy. 

1. BLOOD TEST
Leucocytosis with neutropenia and monocytosis.



IMAGE OF BLOOD TEST HAEMATOLOGY
There was an increase in total white cell count 2 months after purchase. (SHOW BLOOD VALUES).  So the dog had an infection for a long time.

2. INFECTIOUS DISEASE TESTING
2.1 DISTEMPER ANTIGEN TEST KIT
Distemper causes coughing. Test Kit. Negative.

2.2  PARVOVIRUS AND CORONAVIRUS TEST KIT. Negative. 

CONCLUSIONS.
The puppy was not vaccinated against kennel cough. Other viruses like canine distemper, parvovirus and coronavirus could have had infected the puppy but did not cause disease. This is evident from negative test kits to the above-mentioned viruses. (VIDEO FOOTAGE).



 ADVICES
KENNEL COUGHVACCINATION SCHEDULE
SC or IM. Inactivated vaccine. Pneumodog.
Intra-nasal. Live modified vaccine. Broncho-Shield III


PUPPIES
2 vaccinations for puppies

1.  Puppies born from vaccinated bitches
First dose at 6th week
2.  Puppies born from non-vaccinated bitches
First dose from 4th week
Booster vaccination 2-3 weeks and yearly after the lst vaccination

ADULT DOGS for boarding. 7 days before boarding prevents respiratory infection. Some owners had complained that their dogs cough after boarding. Well managed boarding kennels in Singapore require current vaccination to avoid such complaints.

PART 2
Itchy skin  seen purchase 2 months ago. Why?
Ringworm and bacterial infections were present as evident by round skin lesions and bacterial pustules on the body. .

UVL - flourescence +ve
In-tray test. 7 days needed to confirm.




Enforced cage rest
Antibiotics
Good quality food







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2 types of vaccines are available at Toa Payoh Vets.  Pneumodog is an inactivated vaccine that is given under the skin or into the muscle, but no dropped into the nostril unlike Broncho-Shield III..

Broncho-Shield III
is a modified live virus vaccine
Nasal only. Not for injection SC or IM
lst vaccine from the 8th week. Repeat 2-3 weeks later. Annual booster.
7 days before boarding for adult dogs




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Diseases can be fatal to older dogs.
Dogs are family members.
PREVENT DISEASE BY VACCINATION.  Your dog lives to a ripe old age.



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