Saturday, June 29, 2013
1486. EMAIL QUERY. Recurrent UTI in dogs can be frustrating to the owner
On Sat, Jun 29, 2013 at 10:00 AM, ...@gmail.com> wrote:
> I've read your findings on the corgi with recurrent UTI. My dog has been having recurrent UTI also. Ultrasound and X-ray showed no bladder cancer or stones. She's been on C/D diet for at least 6 months, yet she has another UTI with Blood in urine and struvite crystals.
What should be the next step. I'm seeing my vet again but I'm losing some confidence in the doctor because his workload may be keeping him from being able to make an appropriate diagnosis. Any help will be greatly appreciated.
>
> Thank you,
>XXX
EMAIL REPLY FROM DR SING DATED JUN 29, 201
Thank you for your email. I am Dr Sing Kong Yuen from Toa Payoh Vets.
In recurrent UTI, you will need the dog to be examined again (physically and more lab tests to be done).
There are various causes of UTI other than stones and cancer in the bladder. The stones can be present in the kidneys, ureter and urethra in addition to the bladder or there may be developmental defects in the urinary system in which contrast radiography is needed. UTI may be due to management factors.
I presume the X-ray and scan were done 6 months ago and therefore outdated. Try to work with your vet or seek another opinion.
Best wishes
1486. Update: The red-eared glider with the popped out shell and swollen folds
The sister who loved this 8-yeared red-eared slider came with her mum to collect the urn. She appeared to be in her 30s and taller than the average Singaporean Chinese girl. Her fair complexion stood in contrast to her long black dress.
"Shall we throw the urn into the sea or just the ashes?" the mum asked me.
"Usually, the ashes are scattered into the sea," I said. "The urn is not but this is personal."
This terrapin would likely be given some drugged food with steroids as the popped out shell is rarely seen in normal terrapins and I have not seen such cases in my 40 years of practice. In the first place, there is only a handful of adult terrapins being sent to Toa Payoh Vets.
There was one adult terrapin that vomited blood after falling down and the owner phoned me. "There is nothing that can be done in such cases as there is internal injuries and bleeding."
Yesterday, a Sec 1 boy's baby terrapin came in. "Are you sure the terrapin still move?" I asked him. "The terrapin did open his mouth to gasp for air but that was only one time." I told the father that the chances of survival are very slim. The terrapin could have dropped from the table to the floor some 2 weeks earlier but the boy was not sure which one. He had two terrapins given as birthday presents by his friend. I ward it for observation.
"Shall we throw the urn into the sea or just the ashes?" the mum asked me.
"Usually, the ashes are scattered into the sea," I said. "The urn is not but this is personal."
This terrapin would likely be given some drugged food with steroids as the popped out shell is rarely seen in normal terrapins and I have not seen such cases in my 40 years of practice. In the first place, there is only a handful of adult terrapins being sent to Toa Payoh Vets.
There was one adult terrapin that vomited blood after falling down and the owner phoned me. "There is nothing that can be done in such cases as there is internal injuries and bleeding."
Yesterday, a Sec 1 boy's baby terrapin came in. "Are you sure the terrapin still move?" I asked him. "The terrapin did open his mouth to gasp for air but that was only one time." I told the father that the chances of survival are very slim. The terrapin could have dropped from the table to the floor some 2 weeks earlier but the boy was not sure which one. He had two terrapins given as birthday presents by his friend. I ward it for observation.
1485. The bleeding black throat skinned Chow Chow
"Skin diseases are expensive to treat and there need to be a review in 3 weeks," I said to the lady owner whose Chow Chow had skin disease for the last 2 years.
Previously, he had a lush coat as evident from her mobile phone images. She had sent the dog to the SPCA earlier but had changed her mind about putting him to sleep.
"The Chow Chow had recovered after treatment in March 2013 by me for ringworm and so I did not come for the review you wrote in the receipt to come 3 weeks later."
"Do you have any phone images of the dog recently?" I was told there was none.
Now the dog was very itchy and large areas of blood spots exist on both ears, behind the ears, on the backbone area and parts of the body. The skin below the neck and the ear flap were bald and black with pigmentation. The face was black.
"There are Chow Chow owners who shampoo the dog daily for the next 14 days and gave the medication on time and the dog recovers if the owner has time to treat him," I was told that this Chow Chow was bathed once a week. The anti-shampoo bottle I prescribed was still available and so I doubted that the dog was properly shampooed or medicated.
Medical costs are higher if the owner does not do the necessary home treatment. I had also prescribed an ear ointment but it was not used. The dog just would not cooperate and so the owner left him alone. Over the last 2 months, the itchiness exploded intensely resulting in large bleeding areas due to scratching.
Yet 2 years ago, the Chow Chow had a good thick coat, judging from the phone images. "A large black hairless area is present over the back in your image of 2 years ago," I said. Surprisingly, the mobile handphone images appear not to have any dates or we could not find the dates. There was visual evidence that the skin disease could have started on the bald backbone patch near the hips as that area should not be black pigmented and hairless. It is hard to say.
The owner would shampoo the dog daily and give the medication. As there was only one breadwinner in this family, it was difficult to budget for the dog's skin disease treatment.
Previously, he had a lush coat as evident from her mobile phone images. She had sent the dog to the SPCA earlier but had changed her mind about putting him to sleep.
"The Chow Chow had recovered after treatment in March 2013 by me for ringworm and so I did not come for the review you wrote in the receipt to come 3 weeks later."
"Do you have any phone images of the dog recently?" I was told there was none.
Now the dog was very itchy and large areas of blood spots exist on both ears, behind the ears, on the backbone area and parts of the body. The skin below the neck and the ear flap were bald and black with pigmentation. The face was black.
"There are Chow Chow owners who shampoo the dog daily for the next 14 days and gave the medication on time and the dog recovers if the owner has time to treat him," I was told that this Chow Chow was bathed once a week. The anti-shampoo bottle I prescribed was still available and so I doubted that the dog was properly shampooed or medicated.
Medical costs are higher if the owner does not do the necessary home treatment. I had also prescribed an ear ointment but it was not used. The dog just would not cooperate and so the owner left him alone. Over the last 2 months, the itchiness exploded intensely resulting in large bleeding areas due to scratching.
Yet 2 years ago, the Chow Chow had a good thick coat, judging from the phone images. "A large black hairless area is present over the back in your image of 2 years ago," I said. Surprisingly, the mobile handphone images appear not to have any dates or we could not find the dates. There was visual evidence that the skin disease could have started on the bald backbone patch near the hips as that area should not be black pigmented and hairless. It is hard to say.
The owner would shampoo the dog daily and give the medication. As there was only one breadwinner in this family, it was difficult to budget for the dog's skin disease treatment.
1484. Facial swelling and itchy eyes the night before - Miniature Schnauzer
June 28, 2013
Since it was after closing hours on June 27, 2013, I advised the dog owner to put on the e-collar so that his Miniature Schnauzer will not scratch his face and eyes. "It is likely an allergy to something," I said. "Bring the dog in the morning for a check up."
I did not expect the owner to come as the dog had recovered. But the couple turned up. I examined the dog's face and eyes. The dog was alert and there was no swelling or scratching. The only symptom was that the dog screamed and pushed his head away when I checked his ears with a cotton bud tip. All dogs with no ear inflammation will not scream. So that was the only finding. I sent the dog home with an ear ointment.
"It will not be the food," the husband responded to my theory that one cause could be a dry food allergy. "I feed him the same brand of food." I did not comment as the same brand of food may have substituted or new ingredients nowadays as the manufacturer seeks to cut costs and quality to be competitive. Eating the same brand may lead to allergies over time but few owners will agree.
Usually I give an anti-allergic injection but in this case, I did not do it so as to lower medical costs. The husband's printing business was not good when he told me he had sublet the shop to another retiree. "I am a taxi driver at night."
"How long have you been a taxi driver?" I asked.
"The past 3 years. I need to go to work. Can you speed up the examination?"
The faster the veterinary service, the better for some clients.
In the afternoon, the wife phoned to say that the dog was lethargic. "He would not respond to going out. He vomited after eating."
I got the dog warded. Took a blood test and gave the anti-allergic injection and IV drip. This is likely an allergy to something consumed but it is hard to prove.
Dogs are children for many couples but the recession on the ground has set in for the heartlander, but judging from the large increase in property and car prices recently and the great difficulty in hiring Singaporeans for many jobs, there seem to be a boom when you consider that 1 in 4 young adult European is unemployed.
A blood test may or may not show what is the cause of this itchiness. Allergies can cause a dog to scratch furiously his face, eyes, ears and body and bites his paws. It is difficult to find the cause and I usually advise a change to an anti-allergic food trial for 3 months.
Since it was after closing hours on June 27, 2013, I advised the dog owner to put on the e-collar so that his Miniature Schnauzer will not scratch his face and eyes. "It is likely an allergy to something," I said. "Bring the dog in the morning for a check up."
I did not expect the owner to come as the dog had recovered. But the couple turned up. I examined the dog's face and eyes. The dog was alert and there was no swelling or scratching. The only symptom was that the dog screamed and pushed his head away when I checked his ears with a cotton bud tip. All dogs with no ear inflammation will not scream. So that was the only finding. I sent the dog home with an ear ointment.
"It will not be the food," the husband responded to my theory that one cause could be a dry food allergy. "I feed him the same brand of food." I did not comment as the same brand of food may have substituted or new ingredients nowadays as the manufacturer seeks to cut costs and quality to be competitive. Eating the same brand may lead to allergies over time but few owners will agree.
Usually I give an anti-allergic injection but in this case, I did not do it so as to lower medical costs. The husband's printing business was not good when he told me he had sublet the shop to another retiree. "I am a taxi driver at night."
"How long have you been a taxi driver?" I asked.
"The past 3 years. I need to go to work. Can you speed up the examination?"
The faster the veterinary service, the better for some clients.
In the afternoon, the wife phoned to say that the dog was lethargic. "He would not respond to going out. He vomited after eating."
I got the dog warded. Took a blood test and gave the anti-allergic injection and IV drip. This is likely an allergy to something consumed but it is hard to prove.
Dogs are children for many couples but the recession on the ground has set in for the heartlander, but judging from the large increase in property and car prices recently and the great difficulty in hiring Singaporeans for many jobs, there seem to be a boom when you consider that 1 in 4 young adult European is unemployed.
A blood test may or may not show what is the cause of this itchiness. Allergies can cause a dog to scratch furiously his face, eyes, ears and body and bites his paws. It is difficult to find the cause and I usually advise a change to an anti-allergic food trial for 3 months.
Friday, June 28, 2013
1483. A visit to the wet market - 628 AMK Market
Today, Friday, Jun 28, 2013, I visited 628 AMK Market, a wet market that has more vacant stalls than some 5 years ago.
At least 4 fish stalls were not open. "What happened? No business?" I asked the lady fish-monger of 10 years at stall 01-177. She said: "Some operators have retired, some open later."
However, a lady customer in her late 40s said: "One stall had not opened in the past 2 months!"
"You are a good mother," I said. "Instead of going to air-conditioned supermarkets to buy fish, you buy from the wet market where the fish is more fresh."
"I have NS boys to feed," she referred to her sons in NS (National Service). "In any case, I don't know how to buy fish at the supermarket."
In supermarkets, the fish is frozen for many days or weeks, in my opinion shared by those who shop at the wet markets. In the wet market, the fish-monger is more a friend who will be honest with you as regards the condition of the fish. Whether it is fresh or not and its origins. In supermarkets, you have to take chances. I wanted to buy the fish used for nasi-lemak rice but she had none. I bought 4 pieces of Norweigian salmon, silver fishes for omelette, a small pomfret and 2 slices of the type of fish the Chinese cook for pregnant women after birth believing it is nutritious for them.Total cost was $52.00.
I rarely market anyway and today was an exception as I wanted to take a video of the wet market at 6.30 am and buy a sweet water melon from Fatty fruit seller for the family. I visited the Lai Lai Hock Aquarium. The old man selling terrapins could not hear me when I asked how old the terrapins were. "$2.50 for one and $2.00 for the plastic container," he kept repeating. I just visited to see the baby terrapins, not to buy them.
As for my camera, I discovered I did not have the battery.
At least 4 fish stalls were not open. "What happened? No business?" I asked the lady fish-monger of 10 years at stall 01-177. She said: "Some operators have retired, some open later."
However, a lady customer in her late 40s said: "One stall had not opened in the past 2 months!"
"You are a good mother," I said. "Instead of going to air-conditioned supermarkets to buy fish, you buy from the wet market where the fish is more fresh."
"I have NS boys to feed," she referred to her sons in NS (National Service). "In any case, I don't know how to buy fish at the supermarket."
In supermarkets, the fish is frozen for many days or weeks, in my opinion shared by those who shop at the wet markets. In the wet market, the fish-monger is more a friend who will be honest with you as regards the condition of the fish. Whether it is fresh or not and its origins. In supermarkets, you have to take chances. I wanted to buy the fish used for nasi-lemak rice but she had none. I bought 4 pieces of Norweigian salmon, silver fishes for omelette, a small pomfret and 2 slices of the type of fish the Chinese cook for pregnant women after birth believing it is nutritious for them.Total cost was $52.00.
I rarely market anyway and today was an exception as I wanted to take a video of the wet market at 6.30 am and buy a sweet water melon from Fatty fruit seller for the family. I visited the Lai Lai Hock Aquarium. The old man selling terrapins could not hear me when I asked how old the terrapins were. "$2.50 for one and $2.00 for the plastic container," he kept repeating. I just visited to see the baby terrapins, not to buy them.
As for my camera, I discovered I did not have the battery.
1482. Vasectomy in a male German Shepherd X
The owner asked a lot of questions testing the patience of the vet.
"Does it mean that your quotation for a neuter of a 5-15-kg male dog of $200-$250 is proportional to the weight of the dog? If my dog weighs 5 kg, does it mean I pay $200?"
"No," I said. "The cost depends on the time taken and complications. The quotation is a guideline."
He asked other questions like whether the dog's behaviour will be quieter and lazier after neuter and whether it is possible to neuter without changing the dog's personality? This retiree must have done his research as there is the vasectomy which is equivalent to the traditional neuter in that the spermatic cords are cut off and the male dog is unable to make female dogs pregnant.
When he cancelled the appointment to neuter, I said it was OK. No questions asked. No hard pressure sales talk. Suddenly he appeared with the cross-bred inside a medium sized kennel. "I had to use a treat to coax him inside this kennel," the senior citizen said to me. I could see that the dog was nervous and so I did not take him out till later. The man drove a hard bargain including the e-collar.
I did the vasectomy with Dr Daniel on Jun 27, 2013. Vasectomy is rarely done in Singapore dogs and I had done only a handful of cases over the past 40 years of practice. So Dr Daniel was considered fortunate to get a case. "I had advised him to neuter by removal of the two testes," Dr Daniel had also spoken at length with this retiree the day before.
"Give what the client wants," I advised. "If he wants vasectomy, there must be reasons. It should be a quicker operation than the usual neuter.'
I was mistaken. For this big dog, I was the mentor and Dr Daniel was the operating surgeon. The location of the first spermatic cord was difficult to find. There was the artery next to it and this must not be cut. The large veins of 8 mm across were easy to see and must not be cut as the blood supply to the testes would be gone.
We got 1.5 cm of the spermatic cords ligated and cut off. The dog weighed 20 kg, not 5-15 kg but I did not hustle the retiree for an additional cost. The retiree had fixed the cost as $260 with the e-collar and medication and I let sleeping dogs lie. It was a learning experience for me as regards costing and I am sure Dr Daniel had benefitted from this rare type of surgery operating together with me. Over the years, I hope he would have honed his skills and be a top a veterinary surgeon of diverse surgeries in pets. Unlike human medicine, the surgeon may just specialise in one system such as the heart surgery but in vets, they are supposed to be able to operate on many systems.
"Does it mean that your quotation for a neuter of a 5-15-kg male dog of $200-$250 is proportional to the weight of the dog? If my dog weighs 5 kg, does it mean I pay $200?"
"No," I said. "The cost depends on the time taken and complications. The quotation is a guideline."
He asked other questions like whether the dog's behaviour will be quieter and lazier after neuter and whether it is possible to neuter without changing the dog's personality? This retiree must have done his research as there is the vasectomy which is equivalent to the traditional neuter in that the spermatic cords are cut off and the male dog is unable to make female dogs pregnant.
When he cancelled the appointment to neuter, I said it was OK. No questions asked. No hard pressure sales talk. Suddenly he appeared with the cross-bred inside a medium sized kennel. "I had to use a treat to coax him inside this kennel," the senior citizen said to me. I could see that the dog was nervous and so I did not take him out till later. The man drove a hard bargain including the e-collar.
I did the vasectomy with Dr Daniel on Jun 27, 2013. Vasectomy is rarely done in Singapore dogs and I had done only a handful of cases over the past 40 years of practice. So Dr Daniel was considered fortunate to get a case. "I had advised him to neuter by removal of the two testes," Dr Daniel had also spoken at length with this retiree the day before.
"Give what the client wants," I advised. "If he wants vasectomy, there must be reasons. It should be a quicker operation than the usual neuter.'
I was mistaken. For this big dog, I was the mentor and Dr Daniel was the operating surgeon. The location of the first spermatic cord was difficult to find. There was the artery next to it and this must not be cut. The large veins of 8 mm across were easy to see and must not be cut as the blood supply to the testes would be gone.
We got 1.5 cm of the spermatic cords ligated and cut off. The dog weighed 20 kg, not 5-15 kg but I did not hustle the retiree for an additional cost. The retiree had fixed the cost as $260 with the e-collar and medication and I let sleeping dogs lie. It was a learning experience for me as regards costing and I am sure Dr Daniel had benefitted from this rare type of surgery operating together with me. Over the years, I hope he would have honed his skills and be a top a veterinary surgeon of diverse surgeries in pets. Unlike human medicine, the surgeon may just specialise in one system such as the heart surgery but in vets, they are supposed to be able to operate on many systems.
Thursday, June 27, 2013
1481. Thursday's 4 new clients - varied problems.
Thursday Jun 27, 2013. Today is surprising in that 5 new clients whom I had not seen before, came in a row in the morning.
Case 1. The owner of this Alsatian X phoned to cancel the neuter appointment at 10 am and so I was surprised to see him turning up. He made the appointment with Dr Daniel yesterday. I had talked to him as he had some queries. "Actually there are two types of neutering," I said to him. "One is vasectomy in which part of the spermatic cord is cut away so that the dog does not breed. The other is the usual removal of the testes. Most dog owners ask for the 2nd method as this make the male dog less aggressive and display less anti-social behaviour like urine marking.
The owner wanted vasectomy so that his dog will not change his character. So vasectomy would be the answer to his reason to save $70-$14=$56 for the annual dog licence of a neutered dog.The dog is only aggressive towards other dogs. He looks nervous inside the crate and so we have to be careful.
Case 2. The gentleman kept picking out ticks for the past 2 weeks. "I used the Frontline spot-on late," he said. Frontline should be used 3-4 weekly regularly. Ticks stuck under the lush thich coat. "Clipping bald is the solution," I said. The dog was also nervous, moving his head to and fro. I gave IV dom + ket at 50% for this 10 kg dog. Just sufficient to clip without him biting. I taught my assistant how to use the clipper size 10 rather than size 40 as there is no need to clip bald to the skin. He mumbled less now but the use of clippers is never taught in vet schools including his Myanmar Vet University.
Case 3. The lady and her mum came in with a 8-year-old Terrier X and her fractured tooth. "Is it common to have older dogs dropping teeth?" she asked me over the phone yesterday and made an appointment. "It is common if the tooth is loose and decayed," I replied. When I examined the dog today, the tooth was fractured half way at the gum level. "Your dog bites metal or solid objects," I said. The lady confirmed. "That is why this left upper Incisor 3 is broken. I have to get the root extracted. Dark brown stains in the back teeth. Otherwise, the teeth are in good condition and white."
The sky is still hazy. The sun is obscured as I write this report at 11.37 am. Three new cases with 3 new challenges. Veterinary practice is never dull.
Case 4. Spaying a ferocious stray cat of around 6 months. The mother and adult daughter came at around 11.30 am with a crate covered with rags. This is part of stray cat rescue of the Yishun group, operating for last 3 years feeding of the stray cats which cost a lot of money. "There is credibility in your work as it exists for 3 years," I said. "But nobody knows it Even if a kind person want to donate some cat food, they don't know where to locate you. Facebook is the best. Record your work, your history of the group and ask for cat food, rather than cash. Don't expect a donor to come to you.
"The Facebook with stray cats sterilised and those needing vet treatment will be put up and over the years, others will come to help you. Personal donations by you will not be possible as there are just too many stray cats to feed! Your daughter should be able to use handphone to take images and upload on Facebook."
"Some vets are charging too much for spay," the mother said.
"It is too much to the volunteer, but vets have very high operating costs and are not a charity funded by outsiders. So, not all vets can sustain such subsidized services out of their own account too."
Case 5.
"My cat started to scratch my expensive furniture," the lady said to me. The cat was declawed by Vet 1 on April 4, 2013. "This cat was brought in by my son but now he is not responsible. LF and RF
Case 1. The owner of this Alsatian X phoned to cancel the neuter appointment at 10 am and so I was surprised to see him turning up. He made the appointment with Dr Daniel yesterday. I had talked to him as he had some queries. "Actually there are two types of neutering," I said to him. "One is vasectomy in which part of the spermatic cord is cut away so that the dog does not breed. The other is the usual removal of the testes. Most dog owners ask for the 2nd method as this make the male dog less aggressive and display less anti-social behaviour like urine marking.
The owner wanted vasectomy so that his dog will not change his character. So vasectomy would be the answer to his reason to save $70-$14=$56 for the annual dog licence of a neutered dog.The dog is only aggressive towards other dogs. He looks nervous inside the crate and so we have to be careful.
Case 2. The gentleman kept picking out ticks for the past 2 weeks. "I used the Frontline spot-on late," he said. Frontline should be used 3-4 weekly regularly. Ticks stuck under the lush thich coat. "Clipping bald is the solution," I said. The dog was also nervous, moving his head to and fro. I gave IV dom + ket at 50% for this 10 kg dog. Just sufficient to clip without him biting. I taught my assistant how to use the clipper size 10 rather than size 40 as there is no need to clip bald to the skin. He mumbled less now but the use of clippers is never taught in vet schools including his Myanmar Vet University.
Case 3. The lady and her mum came in with a 8-year-old Terrier X and her fractured tooth. "Is it common to have older dogs dropping teeth?" she asked me over the phone yesterday and made an appointment. "It is common if the tooth is loose and decayed," I replied. When I examined the dog today, the tooth was fractured half way at the gum level. "Your dog bites metal or solid objects," I said. The lady confirmed. "That is why this left upper Incisor 3 is broken. I have to get the root extracted. Dark brown stains in the back teeth. Otherwise, the teeth are in good condition and white."
The sky is still hazy. The sun is obscured as I write this report at 11.37 am. Three new cases with 3 new challenges. Veterinary practice is never dull.
Case 4. Spaying a ferocious stray cat of around 6 months. The mother and adult daughter came at around 11.30 am with a crate covered with rags. This is part of stray cat rescue of the Yishun group, operating for last 3 years feeding of the stray cats which cost a lot of money. "There is credibility in your work as it exists for 3 years," I said. "But nobody knows it Even if a kind person want to donate some cat food, they don't know where to locate you. Facebook is the best. Record your work, your history of the group and ask for cat food, rather than cash. Don't expect a donor to come to you.
"The Facebook with stray cats sterilised and those needing vet treatment will be put up and over the years, others will come to help you. Personal donations by you will not be possible as there are just too many stray cats to feed! Your daughter should be able to use handphone to take images and upload on Facebook."
"Some vets are charging too much for spay," the mother said.
"It is too much to the volunteer, but vets have very high operating costs and are not a charity funded by outsiders. So, not all vets can sustain such subsidized services out of their own account too."
Case 5.
"My cat started to scratch my expensive furniture," the lady said to me. The cat was declawed by Vet 1 on April 4, 2013. "This cat was brought in by my son but now he is not responsible. LF and RF
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