Monday, September 5, 2011

580. E-mail Query: Cost of neutering a 3-month-old guinea pig at Toa Payoh Vets



On Sun, Sep 4, 2011 at 8:50 PM, ...@yahoo.com.sg> wrote:

Hi,

I have a guinea pig close to 3 months old and I would like to send him for neutering.
what is the cost and how long does it take?

Regards,
...


E-MAIL REPLY FROM DR SING DATED MONDAY SEP 5, 2011

I am Dr Sing from Toa Payoh Vets. Thank you for your email.

The cost for surgery and anaesthesia is estimated to be around $75. An antibiotic and painkiller injection would be $30. Total is estimated to be around $105. It takes around 30 minutes for the whole process. Bring the guinea pig in the morning and take him home at 5 pm in the evening.

579. Elective Caesarean Section for a heavily pregnant Chihuahua - 60th day

"When is the best time to perform an elective Caesarean Section on a Chihuahua?" I asked a vet. "64th day?" was the reply.

"Much depends on the signs of impending birth," I said. "From my two hectic years of experience with the dog breeders in Pasir Ris, it will be around 60-63 days for a heavily pregnant Chihuahua. 58th day was the earliest I did to get viable puppies. It is best to do after 60th day as the pups are developed and not premature like being hairless."

One home breeder phoned me last week (without having met me at all) and I advised 60th day based on rectal temperature and signs. I advised him to buy a thermometer to monitor the rectal temperature and after that heard nothing from him by phone.

When the temperature drops and the dog stops eating or pants, it is time. I advised that there would be no point in just checking out the dam if she was OK unless he wanted ultrasound to be done. This was to save the home breeder some money as costs are important to many home breeders.

Below is an e-mail from this home-breeder.


E-MAIL TO DR SING DATED SUNDAY SEP 5, 2011, 10.51 PM


Dear Judy,

I am ... that called and fixed appt with Dr Sing for tomorrow's Ops on my Chihuahua (on her 60th day of pregnancy).

Pls help to check with Dr Sing and advise me on my mobile line ....( no matter at what time tonight, it is ok).

My Chihuahua is starting to show very abnormal sign of NO APPETITE for food from tonight( normally it is very excited on serving). She NOT EATING at all even we did not feed for the whole day. She was mated on 7th July and today is her 59th day. This is her first birth.

The rectal temperature measured daily for the last 7 days on every morning is between 38~38.3 degree celsius. This morning was 37.9.

Thanks a lot.
.....

PRICE OF CAESAREAN SECTION AT TOA PAYOH VETS

After office hours, the cost is much higher and would vary from $1,000 - $3,000 depending on the practice. For Toa Payoh Vets, it would be around $1,000.

In this case, the elective Caesarean section could be done on a Sunday afternoon but the owner did not phone as I was still working till 4.30 pm. I have not met the owner at all. Caesarean was done by my vet past midnight. I gave him free telephone advice on monitoring the rectal temperature. When it drops below 38 degrees and the dog has milk and shows signs, he should contact me by phone. I did phone him one day ago but got no response or reply.

The cost of around $1,000 was considered expensive by the owner (according to his text message reply to me at 4.40 am on Monday Sep 5, 2011 as I am writing this report). I texted "It costs more after office hours and is around market price."

IN RETROSPECT, the Caesarean section could have been done at 4 pm on Sunday afternoon but the owner did not phone nor keep in contact till after 10 pm when the dog showed more signs. That was around 10.51 pm. Caesarean section was done by Dr Jason Teo and all was OK. The price was around $1,000 which was not so OK with the owner. But it was market price.

Friday, September 2, 2011

DOA - Dead On Arrival - parvoviral Westie puppy

I said to the dog transport man today Fruiday Sep 3, 2011: "Be careful with the transport of the 16-year-old Fox Terrier. I hear that he had collapsed once. May have heart disease. I don't want a DOA - dead on arrival dog."

"Choi, choi," he replied, meaning some counter verses to ward off bad luck. The dog arrived alive.

But there was a DOA. A young man in a car brought a dead Westie puppy he had bought from the dog breeder. The breeder treated it for vomiting and diarrhoea without success and asked him to come to Toa Payoh Vets. It was DOA.

I asked Dr Vanessa to handle the case to see how she would handle this case sensitively and carefully. This is part of my mentoring lessons. Any careless allegations about vaccinations would have impact and led to grievances and litigation. This is where the old vet knows what to do.

There are certain procedures to be done in examination of a DOA puppy. A parvoviral test must be done. This was positive. A vet report must be written. Cremation to be discussed. Who to pay must be made clear as the breeder might not pay for the services. In this case, I showed how the case is handled.

577. Dog breeders in Singapore and parvoviruses killing puppies

"$280 for a Caesarean section of a dog is money-losing," I said to Dr Vanessa today. "I will like you to stop accepting any new breeder business." Whether she accepts my advice or not, time will tell.

In any business, it is best not to work for free or at a loss as money is needed to pay for good staff and replacement. I visited a new veterinary surgery recently. "How come the operating table is an old human operating table with pads?"

The vet said: "It is too expensive to buy the Shoreline veterinary operating table as it costs $7,000". I bought one to replace the old one. This specialised table has a grove in the middle to catch the blood and urine.

Using a human operating table for dog operations is not practical because the blood spills over the sides. In human hospitals in Singapore, there are many nurses and staff to suck out any fluid or blood. But this is not economical in a small vet practice.

In any case, a Shoreline operating table makes veterinary surgery so much more comfortable and pleasant.

To get such tools, the practice cannot afford to be offering free and cheap services to dog breeders as there will not be time to service the private clients and to earn a decent income to buy appropriate tools such as a veterinary operating table, electro-surgical equipment and anaesthetic machines.

This means that I don't accept dog breeders and pet shop operators for the past years as they make the vet work practically for nothing considering the time spent in treating their parvoviral puppies and the need to disinfect and prevent diseases in the practice.

I will put my foot down if my associate vets keep taking in new breeder clients as the practice needs to focus on providing excellent services to the private clients. There is just certain hours in a day and breeders and pet shop operators demand a lot of free consultations and time. Sometimes, I wonder how the other vets catering to breeders can sustain the profitablility of their practice.

At one time, I was serving several big breeders charging $10/vaccination at the farm because the previous vet had his licence suspended and I happened to be at the right place at the right time when a big breeder asked me to service his farm. $10/vaccine was sold to the breeders by this vet without having to go to the farm. I had earlier offered $15.00 and was unsuccessful.

Doing the dog breeder business meant travelling time of over one hour would not being billed. The hope is that new puppy buyers would come and visit me when they need a 3rd vaccination.

Soon, two younger lady vets came to Pasir Ris breeding farms with an offer no sensible dog breeder could refuse. $6.00 per vaccination from the eventual successful young lady vet finally wiped out all the other vets. However, there was another investor who used to bring his vet along in his car, after soliciting the vaccination business from the breeders and pet shops. His rate was lower than me, maybe at $8.00 but higher than the $6.00. I think he was also vanquished.

I exited the breeder's business and spent time with the interesting private clients. Those stay with the vet if the services are good and results are shown although they do stray, as for all service providers.

Today, a 16-year-old Fox Terrier owner and his two daughters now grown up to be in their late 20s came specifically to consult me as he had met me many years ago. It is a continuity and a pleasure to see his two daughters equal to him as adults and making decisions. However, they defer to the father's wishes to consult me and had to take leave from work to do that. I got a dog transport man to bring the dog in. Father and two daughters and a dog and a driver in a small van. It was fun to meet them again after all these years.

576. Walk The Talk - parvoviral infection in a Maltese puppy

"It is impossible to collect blood from the Maltese puppy," my assistant Min told me. "The blood just will not flow out from the vein."

The 2-month-old Maltese puppy was warded 18 hours ago for vomiting and diarrhoea by a dog breeder yesterday at 8 pm. Vet 1 gave an antibiotic and anti-vomiting injection.

The young lady turned up at 12 noon today to check out her puppy. There was no diarrhoea. I brought her to see her puppy in the crate. She had got him 5 days ago from the breeder and everything was OK till her mother gave the puppy an egg on the 5th day.

At the crate, he was inactive but standing. Suddenly he vomited yellow froth.

Based on the history of one vaccination, I suspected that this puppy had parvoviral infection. In any case of puppies having vomiting and diarrhoea, the process of examination should include faecal parvoviral test. However since this puppy was billed to the breeder, he had not wanted parvoviral and blood test to be done.

I took over the case since the owner came and would accept responsibility of payment for the treatment had this done today although the puppy was no longer purging. The test was positive.

I phoned the owner to let her know the bad news. I had earlier told her that the puppy had pale gums and was losing blood internally. "Parvoviruses are puppy killers," I said. "Chances of survival are very slim." She had given permission for blood test

So I had the blood test to be collected. As the puppy was dehydrated, the blood was dark blue and thick. So my assistant and another could not suck n blood and came to let me know. The cephalic vein could have had collapsed and this 850-g Maltese and so it was very hard to draw blood.

What to do? Just forget about it?

"Blood can be collected from the jugular vein," I said. "Have you collected blood from the jugular vein in the cow in Myanmar?" My assistant Min who is graduated as a vet in Myanmar said no. I had collected blood from the jugular vein in a few hundred racehorses when I was a horse vet and could apply the same procedure in collecting blood from the puppy. Depress the jugular grove and the base of the neck near the scapula.

I walk the talk. "Use a 1-ml syringe," I coached Min who always uses 2.5 ml syringe as a standard. "Push the piston in and out to ensure it moves freely." As one assistant held the puppy's head, the other pressed the jugular grove. I inserted the orange 25G needle into the distended jugular vein. Thick dark brown blood of near 0.8 ml was sucked out.

This is a very rare occasion I collect blood from the jugular vein of a 850-gram puppy. The blood is important to assess the viral infection of the blood system and the overall health of this puppy. The puppy pressed his head against the crate side. This was not a good sign as it could indicate "headache" or pain as I had seen many of such presentations in puppies with severe distemper viral infections.

Walk the talk is important if one is to lead. Or seek expertise to help.

House call to see a 16-year-old Fox Terrier

It was many years since I saw the Fox Terrier who now cannot stand up properly and has some lumps and infections in his backside. The owners asked me to make a house-call and did not mind paying the fee of $300 as the dog might be stressed out and die on the way to Toa Payoh Vets.

This is not the right way to practise veterinary medicine as a house-call would achieve nothing for the old dog. I said: "From your description, the old male dog would be suffering from anal sac infection and circum-anal tumours which need to be excised. So, a house-call would not help this dog at all and your money would be spent for with no valuable services to you."

I arranged the pet transport man to bring the dog down for inspection. That would be better for the old companion as proper nursing and surgery cannot be achieved at home.

In old dogs (over 8 years old) requiring surgery, don't use domitor or any sedative IV. Halothane + oxygen gas would be safest. Ensure that the dog has an IV drip and antibiotics some 4 hours prior to surgery. Usually the normal healthy old dog survives.

The emaciated Shih Tzu has pemphigus vulgaris? Reviewed 4 days later

Thursday, Sep 1, 2011

"My dog looks forward to coming to your Surgery," the daughter said to me. "She used to be afraid of going to the vet." I was surprised to see this 10-year-old Shih Tzu so much more energetic and wagging his tail, as if she wanted to enjoy every second of living.

4 days of medication and better food like meat and eggs and she looked so full of energy. I had scheduled the operation at 10 am but since the owners had problems getting a taxi on the road side, the dog's body felt very hot. I had to postpone the surgery to next Monday as it is not wise to operate a dog that is hyper-excited. This is an old dog with poor nutrition as Vet 1 had advised to feed only vegetables and rice as the dog suffered from skin diseases, including big ulcerations in both ears and below the pads of all paws. The owner said that the original skin problem started with the ears. Vet 1 had diagnosed an auto-immune skin condition called pemphigus* and so advised vegetables and rice only.

"We had been waiting for the taxi for one hour and under the sun," the daughter said. "Next time, I will book a taxi."

This could be a case of pemphigus vulgaris and pemphigus foliaceus. The owners complained that the dog had blisters or ulcers in the ears first (I took some pictures - pemphigus foliaceus starts as blisters in the ears and spreads to the body but does not involve the mouth).

In this case, the mouth got ulcers esp. at the skin-mouth junction. Pemphigus vulgaris involves the muco-cutaneous junctions but not pemphigus foliaceus). Now the dog also has "ulcers" in both ears, ulcers in the mouth-skin junctions and all the pads of the 4 limbs. I have images to show later.

The prednisolone injection given did suppress the auto-immune system. The submandibular lymph nodes are now not spreading caudally like a long cord involving the other lymph nodes, as at 4 days ago. The swelling is now localised at the submandibular lymph nodes which are around 3 cm x 3 cm x 2 cm - very large.

I took a blood test and would review the case 3 days later again. Biopsies for histopathology would need to be specially prepared to get good lab results and these may be costly.

In conclusion, this could be a case of pemphigus vulgaris and pemphigus foliaceus. Long-term immunosuppressive treatment and regular monitoring would be the treatment. Over-treatment will kill the dog and so there must be a long-term care and blood test for this dog.

*REFERENCE
Pemphigus and Pemphigoid in Domestic Animals:
An Overview - Can Vet J 1985; 26: 185-189.
LOW ELL J. AC K ERMAN
Denison Veterinary Services,
1151 Denison Street, Suite 2,
Markham, Ontario L3R 3 Y4
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1680036/pdf/canvetj00606-0015.pdf

In pemphigus foliaceus and vulgaris, diagnosis is based on history, clinical signs, histopathology and immunopathology. Therapy must be immunosuppressive to be effective and is palliative rather than curative.

In practice, it costs a lot of money to diagnose this skin disease. The owner had spent quite a large sum of $2,000 previously. In this case, rather than making the owner to spend more money on biopsy, I consider that it is best to get onto the immunosuppressive treatment and regular 3-monthly monitoring of blood to ensure that the dog is not killed by over-treatment of the immuno-suppressive drugs.

That would be in the best interest of the owner and the dog. I will review in 4 days' time, ie. on Monday. The dog is much well loved as a family member especially the daughter. Pemphigus is a rare skin disease in dogs and so is sometimes diagnosed as allergies to dry dog food - hence Vet 1's recommendation of home-cooked vegetables and rice.