Friday, May 31, 2013

KPI - neutering a normal poodle using IV anaesthesia Dom + Ket

May 31, 2013

"Double ligation is better," I said to my assistant Naing. "Sometimes the ligature slips and the dog bleeds leading to a much swollen scrotal sac. But most vets will ligate once." I was giving Naing, a young vet graduate from Myanmar some tips.

KPI
How long it takes me to neuter a poodle? For knowledge gathering purposes, I record the times.

Poodle, M, 1 year, two normal descended testicles, 4.85 kg.
Anaesthesia - Domitor + Ketamine 0.2 + 0.25 ml IV, one syringe.
"No need to prepare isoflurane," I said to Naing who was getting ready to switch on the oxygen and isoflurane. "The dosage is sufficient if the vet is fast."


1.47 pm Injection IV Dom + Ket
1.56 pm First skin incision. 2 testicles removed, double ligation per testicle into grooved clamped area
2.12 pm  Skin stitched. Dog started to move legs at this time.

Surgery time -  2.12 - 1.56 = 16 minutes
Duration of surgical anaesthesia without isoflurane top up 2.12 - 1.47 = 25 minutes.
Dog is young and healthy but thin.  

Goes home at 4 pm, no problem.
"What's the black area?" the man asked.
"Actually it is part of the scrotal sac. The other part is not black due to continuous licking. It becomes pink and hairless.

A little girl came. "This poodle is her dog," the mum said. "The old Schnauzer with heart disease you put to sleep on Vesak Day is my dog."
"How old is she?" I asked as she had cried that day when she was not allowed to see the dog after euthanasia. Fair complexion, big eyes and bright.
"3 years old," she said.
"I thought she is 6 years old," I replied. 

1440. Ascites

Yesterday, the 6-year-old Jack Russell came in with a huge tense abdominal swelling. "He still runs and eats," the owner and a young man said. "What is the problem?"

I examined it. Percussion. An abdominal exudate needs to be collected and examined.. Will do the basic tests of blood and urine as the owner has a budget.

1439. NIMBY Syndrome - A polluting generator with an exhaust pipe at the back of Toa Payoh Vets


Friday
March 31, 2013

After assuring me that the company would relocate this generator with a blue-smoke exhaust pipe away from the space between the back of my surgery and the restaurant's cooking area, the Filipino staff installed a 10-foot high pipe to re-direct the smoke upwards to the 2nd floor.

"This should be OK," he said.
The smoke is now more visible and the air blew it into the units in floor one.
"I was told that the unit will be relocated just yesterday by the managing agent but obviously, this company has no intention of doing it."

The smoke had drifted into the back of the surgery and into the kitchen of the restaurant. I do eat in this restaurant. But nobody cares about eating polluted food. 20-30 years many Singapore cars and lorries emit such blue smoke from the exhaust pipes but now you seldom see any. But this generator does it. It would be at least 2 months of smoke. Imagine yourself breathing such smoke from the vehicle's exhaust pipe for a few hours a day.

The managing agent, the contractor and the supplier of this generator would be the parties involved.They did not see the effects of the smoke on the kitchen cooking, poisoning the staff and food for the workers.

I followed up again and again. The supplier wanted to meet me at 11 am today to "seek my solution" but was tardy. I had to postpone one surgery to wait for him. The Filipino man said that he would get a crane and relocate the generator by Monday 12 noon. The long black pipe to re-direct the smoke was not long enough and in any case, the smoke just settled downwards again.

NIMBY means "not in my backyard" happens to everybody. If the company can erect a pipe 10 stories high, it may be possible to resolve this problem, not just 10 feet high. Electricity generators are smoky but are there ones with no smoke? Just like the cars, buses and lorries in Singapore nowadays?

  

1438. A well loved dog passed away


tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   30 May, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
A well loved dog passed away
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   30 May, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1438. A well loved dog passed away

Lhasa Apso 9 years, 2 very small breast tumours. Toa Payoh VetsI received an email dated May 27, 2013 from a lady who loves her dog very much. I always feel the loss of my client's older dog from illness or cancer at nearly 14 years of age. The dog was said to have suffered from lymphoma. At 9 years of age, I spayed her as she was suffering from open pyometra and being old, some vets would not operate on her.  She survived the anaesthesia and the surgery in 2008. She thrived due to the high quality of care from the couple.   

 
May 27, 2013

Dear Dr. Sing,

It has been a long time since we last communicated.  I hope you have been well.  I see you have been busy traveling now that you have more or less retired from running your clinic full time. I do see from your website that you still work at Toa Payoh Vets part-time.

CC passed away last month on 22 April 2013, just a week short of her 14th birthday.  She had been diagnosed with chronic kidney failure for a couple of years and in May 2012 she collapsed and was very lethargic.  She spent 4 nights at the vet on IV drip and that hospital stay restarted her kidneys. Since she came home on 17 May 2012 to the last day of her life, I had been giving her daily subcutaneous fluid injections at home.  As you know, this was only to maintain her quality of life, and not a form of treatment.

CC had always been patient and brave with the daily jabs.  In the end it was not the kidney failure that took away her life, but an undiagnosed gastro-intestinal tumor that grew so aggressively.  In the last one week of her life, she was in and out of hospital 3 times, staying around 2 nights each time.  On her last night at home, she pooed blood, had 4 seizures and was just so weak.  She passed away on Monday morning 22 April at the vet clinic on the operating table after the vet Dr. XXX opened her up and found the cancer was too big and deep.

I thought I should write to let you know.  As you know, CC has always been very precious to R and me.  I tried my best as long as I could and poor CC hung on to stay with me too, but it was just too tough for her physically.  I always remember you as her first vet and look upon you with utmost respect because you were the one who operated on her when she was 9 years old when no other vet in Singapore would.  It was after that surgery you performed when I nursed her back to health that our bond deepened.  I still keep digital and printed records of that spay surgery as well as the dental scaling you performed for her.

Thank you very much for your kindness to my beloved CC.

Best regards,
L
 
EMAIL REPLY FROM DR SING dated May 28, 2013

Thank you for updating me about CC and please accept my condolences.

Do let me know if I can be of any help or to talk to. She lived to a ripe old age of 14 years and I am most happy that she has been well cared for, judging from the images I see from your blog which I visited now and then.

Prettied the Lhasa Apso for the vet? Toa Payoh VetsP.S. I phoned the owner as emails are very impersonal and it would be too much grief for her to phone me.

Old dogs are a high risk anaesthetic case and it is not surprising that the other vet did not want to do it as death on the operating table ruins the vet's reputation since some owners will post on internet forums, Facebook and blogs publicising his name, practice and the dog's death for the whole world to know.

No explanation is acceptable when a beloved dog dies on the operating table. I could consider myself lucky in this case. The case study of this Lhasa Apso at:
http://www.bekindtopets.com/dogs/20080912Complications
_bleeding_pyometra_ToaPayohVets.htm
 
Updates will be on this webpage:
http://www.sinpets.com/F6/20130530pyometra_old_dog
_toapayohvets.htm
 
More info at: Dogs or Cats
To make an appointment:
e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: May 30, 2013

Toa Payoh Vets

1439. A 10-year-old Schnauzer has fits and collapses suddenly

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   31 May, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Fits in a Schnauzer 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   31 May, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1439. A 10-year-old Schnauzer has fits and collapses suddenly

 
May 29, 2013

"Do you remember you operated on his ears?" the mother and daughter brought in a white Schnauzer that had fits and collapsed just over one hour ago. The dog had white and cyanotic tongue and was breathing fast. I put him on oxygen therapy first as he had insufficient oxygen for his red blood cells, leading to purplish tongue and mucous membranes.

I reviewed the medical records and said: "Yes, he had very painful and itchy right ear and his ear canal was opened up. How's the ear?"

"No more problem," the mother said. "Could the dog be suffering from a stroke?"
"Hard to say at the moment, I need a blood test and examination. It is possible there is a brain abnormality e.g. tumours, infection or bleeding or a systemic infection. I advised a brain scan but that would be costly and so the owners wanted the basic treatment to be done. That included a blood and urine test.
 
The veins were collapsed too. Dr Daniel had to collect blood from the jugular vein. It was not a good sign. Despite intensive treatment, the dog passed away 2 hours later. 

BLOOD TEST
Significant findings are:
1. Total white cell count 18.3 (6-17). N 90% Absolute 16. L 9% Absolute 1.7
2. Red cell count 5 (5.5 - 8.5)
3. Haemoglobin 11 (12-18).
4. Platelets 108 (200-500). Few giant platelets present. No platelet clumps.
5. Uric acid  0.27 (<0 .13="" br=""> 6. SGOT/AST 129 (<81 br=""> 7. Urea 3.4 (4.2 - 6.3). Creatinine levels were normal. 
The blood was taken from the jugular vein. The dog had around 30 minutes of oxygen therapy by mask before the blood and urine were collected.


URINE TEST
pH 5.0 (5-8), SG 1.020 (1.005-1.030), urobilinogen +, blood 4+, bacteria 3+, white blood cells >2250, red blood cells 315.

It is important to practise evidence-based medicine. In this case, the dog could have a septicaemia. There could be a pathogenic type of bacteria picked from sniffing the grass or consuming some poisonous food or treats.

The onset was "sudden" fits and recumbency. There could also be an internal bleeding and breakdown of capillaries. A post-mortem may give a definitive diagnosis as to the cause of death. As it would be costly, this was not advocated by me.

A simple blood and urine test provide some clues of illness at the most economic rates as compared to brain scanning and more tests. In any case, the dog was breathing fast and had white and purplish tongue, indicating a very poor prognosis. However, other tests like brain scan needs to be advised. This Schnauzer has been well cared for as evident by his good size and body condition as so the death was a "sudden" loss to the family. No poisonous food or drink was consumed according to the mother.  

miniature schnauzer, hairy ears, infection, head shaking, rubbing, smelly. singapore, toa payoh vetsThe dog's ears were normal after the surgery as there was no more intense and continuous ear scratching. The case study and lateral ear canal resection surgery is at:
http://www.asiahomes.com/singaporetpvet/dogs/
0750Schnauzer_lateral_ear_resection_Singapore.htm
 
Updates will be on this webpage:
http://www.sinpets.com/F6/20130531
fits_Schnauzer_toapayohvets.htm
 
More info at: Dogs or Cats
To make an appointment:
e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: May 31, 2013

Toa Payoh Vets

Thursday, May 30, 2013

1441. Facebook condemns a vet in Myanmar - vomiting pug with blood in the urine. UTI or urinary stones?

May 29, 2013

A Myanmar vet was condemned by the Facebook posting as the pug he treated for urinary tract infection died. I saw the image of the pug although I could not read the Myanmar postings.  According to my assistant Naing, the vet said there was just urinary tract infection and no bladder stones. The owner had consulted Vet 1 who diagnosed bladder stones from ultra sound and so the owner brought the dog to Vet 1.

When a dog dies, the postings can be very sharp. The dog had been vomiting. So was there bladder stones or not?

"It is possible there is renal failure causing vomiting, but blood tests were not done to show the health of the kidneys. An X-ray could have been done to confirm the bladder or kidney stones."

Based on urine microscopy of "no crystals," the vet came to a conclusion there was no stones despite Vet 1's ultrasound stating there were stones.

Although no autopsy was done to find out the cause of death, the Facebook posting would be harmful to the reputation of the vet practice as the postings spread around the world. .

It is best that a process is used whenever a vomiting dog with haematuria is presented. Blood tests, urine tests and X-rays are mandatory unless the owner declines them. Practise defensive medicine but be compassionate if the owner has financial difficulties.   

1440. Anal sac swelling in a 3-year-old Pom

May 30, 2013

The accountant had to rush here at 7.30 pm after work to get her Pom treated.
"Dr Daniel is in Bangkok today Friday," I said as she asked for him. Dr Daniel had expressed the anal sac in February and she had instructed the dog groomer to do so soon after. Now the dog was not happy with his backside.

"Is there tail chasing or biting?" I asked. "You can consult Dr Daniel as he will be back on Sunday."
However she could not wait and asked me to teach her how to express the anal sacs. They were swollen at around 1 cm x 1 cm but quite deep inside and so I asked her to feel the swelling with her fingers. "At 4 and 8 o'clock deeper in. Pinch the area outwards. Don't let the anal sac oil splatter onto your face or dress as this had happened to my assistant Niang and myself."

So, she had to be careful as this lady in her late 20s had a blue office dress and wanted to know how to do it.

My assistant was present to help hold the dog which is muzzled. After confirming she is right-handed, I said: "Lift up the tail with your left hand, place the tissue to cover the anal opening and press with you right hand's thumb and forefinger."

It was easier said than done. She could not do it.
"You use your fingers to feel the swelling and press while I cover the anal opening with the tissue paper," I said. "Hold the tail upright."

She pressed the anal swellings. The male not neutered Pom growled. He had been patient for some minutes and this was painful.

She squeezed the area.
"The tissue paper has 6 x 6 mm of brown oil contrasted on the white surface. You had success but you took out less than 1%. Let me do it."
The Pom was getting fed up with being a guinea pig.
I expressed an impressive amount of grey granules spreading an area of 5 cm x 4 cm.
"Did Dr Daniel express this much in February when he vaccinated your Pom?" I asked.
"Much more but blacker in colour."
"The anal sacs are still inflamed and the oil still solidifies," I said. I gave a course of medication and asked her to express the sac with her bare fingers to massage it, during the weekly bath.

Education of the client is important but takes a lot of time. Many vets don't have the patience to do it and it is not so easy for a dog owner to do the anal sac expression as in theory.