1191. FIC (FUS, FLUTD) in cats. Dr Susan Little's talk on urethral obstruction, FIC in cats

May 10, 2015. The talk at M Hotel, on Sunday, a Mother's Day was limited to 50 pax and was full house. Dr Susan Little is a co-owner of 2 cat clinics and an author of cat books, amongst other veterinary achievements. Here are some of her opinions.

1.  URETHRAL OBSTRUCTION

1.1 Stablise the cat by decompressing the bladder in some cases, before catherisation. Do cystocentesis. Insert 25-G needle at 45 degrees towards the neck of the bladder. Not at 90 degrees or into the apex of bladder as bladder shrinks away freom the needle when the urine is collected.

1.2. Use a 3-way stop valve to draw urine and collect it for urine analysis

1.3 Massage penile tip for some time - around 10 minutes to express out the urethral plug and so avoid the need to catetherise. This method is successful in some of her cases.

1.4. She uses warmed saline with sterile lubricant to flush the bladder. Apparently the lubricant is effective in cleaering the mucosa.

1.5 A commercial firm sells the appropriate cat cathether. An orange one which is softer for indwelling. The one with the stylet (costs more) but can be used for both purposes - flushing and indwelling. Has a butterfly for suturing to penile skin.

1.6. Pain relief is important. Suggested opiod and NSAID.

Medocab for cats (Boelinger?) is great as it is tasteless and given in the cat's food. She uses it.  Her opinion is that tolfedine is old school and not as good as meloxicam.  

1.7  ACP 2.5 mg/cat oral as anti-spasomodic and anti-anxiety is said to be effective.

1.8. Duration of indwelling catheter depends on lab analysis of urine and blood electrolytes.

1.9. Recurring cases. She did not mention perineal urethrostomy in her lecture.

1.10. Damage to pelvic urethra from catherisation rupture case - dye seen pooling in pelvic area on X-ray shown.

1.11. Blood test. Monitor for K+

2. FIC in cats

2.1  Only 5% are due to bacterial infections. 60-70% idiopathic. Therefore she does not prescribe antibiotics.

2.2 Most cases are self-limiting according to her, whether treatment is given or not.

2.3 Litter boxes insufficient. Should be 4 boxes for 3 cats instead of lesser.

2.4  Pain relief is important. Opiod is her favourite.

3.  NASAL TUBE FEEDING OF CATS

She said it is easy in her practice with the nurse holding the cat. But give sedation if necessary.

Can email to her if you have queries.

1190. How your dog can live longer - The left head-tilting Schnauzer passes away at home

ed Yesterday, May 9, 2015, the 11-year-old Miniature Schnauzer that collapsed twice in the dog-sitter's boarding place passed away at home in the early hours of the morning. He first collapsed and became recumbent and trembling in his whole body around 14 days ago at the dog-sitter.

The daughter of the owner brought the dog to see me. I gave the IV drips and medication and the dog recovered and went back to the dog-sitter the next day.  "The prognosis is poor as he has very low rectal temperature," I warned the daughter.
"Can he survive till my parents come back from Japan?"
"Hard to say, but he started eating and was able to stand in the evening, after treatment."

The dog was OK for the next 4 days. On Sunday, the parents picked him up but he had collapsed again. The father brought him to see me on Monday. The blood test showed only slightly high blood urea but may not be significant. Euthanasia was not acceptable to the wife. After my injections, the dog was active for the next 2 days. He walked 15 minutes in the morning exercise. Then he became restless and paced. He started to breathe fast. These were not good signs.

I examined him again 2 days before his passing away. He was having a sore throat and back pain, probably from being ataxic and falling on his sides against the walls. I gave him a low dose of diazepam sedative IV so he could have rest for the night. I explained this action to the owners (husband, daughter and son-in-law).  The dog did not sleep soundly as the dosage was low. His breathing was fast. 2 days later, he passed away.

From the perspective of an outside vet who had not seen the case at the beginning, his opinion was that diazepam caused his rapid breathing and killed him. The dog's life was ending when he first c collapsed at the dog-sitter and suffered from hypothermia and whole body tremors. Surprisingly, he revived after treatment and went back to the dog-sitter the very next day. He was eating for the next 7 days and the dog-sitter actually took videos of him eating on the last day he was to go home. The owners were given the video clip and had shown to me. The dog collapsed again just on the day the owners came back from Japan to take him home. The husband brought him to me for treatment the following morning. I gave him the injections but he was not back to eating as before. He was pacing, restless and breathing fast. The prognosis was poor. The wife spent the last few days with her beloved dog who passed away at home. The husband texted to me the sad news.

The husband was appreciative and thanked me saying that his wife got to spend some days with her beloved dog at home, after returning from Japan.

This is a situation whereby the vet giving the sedative could be accused of killing the dog. Without sedation, the dog was restless and pacing the whole night. With sedation, he had some rest. His failing health was attributed to something affecting his brain. No MRI imaging of his brain was proposed as this would cost a few thousand dollars, I told the son-in-law.

This dog had not been able to recognise the owners for the last 6 months and was circling to the left. His mind was not normal. But he had good appetite and was much well cared for.

As to what caused his head tilt to the left, I was not the vet to examine him earlier and so I do not know the possible cause or advise a solution. 

However, Schnauzers have hairy ears and ear infections which may rupture the ear drum and cause infections in the middle ear and head tilt. Early detection of ear infections and sometimes surgery to open up the lateral ear canal or remove the vertical canal when the Schnauzer is young may prevent middle ear infections leading to head tilts.

The surgery is called lateral ear canal resection or vertical ear canal ablation.





    

1189. Make a difference in being "kind to pets" - share your knowledge in an e-book

An e-book needs to be concise and edited to help the read. Articles and correspondences in emails and comments on social media may contain too much repetition. Hence I propose you write an e-book "How owners provide good care for dogs with heart and kidney failure"

Your experiences with various owners on how to treat kidney and heart failure at home, after visit to the vet will be extremely welcome by owners. Most owners do not know how to give home nursing and most dogs do not accept medications. So, your in-depth research of your dog as well as other owners will be most useful in the e-book. Just these 2 diseases - heart and kidney failure from the owners' perspective.

Vets are quite busy and need to  keep medical and consultation costs down/ owner and reduce waiting time. There are only a limited number of working hours and if one owner takes 60 minutes to ask questions including examination (as had happened in some of mhy cases), this may not be practical. Other owners have to tolerate 2-3hour waits and get fed up or go elsewhere. It is best for owners to read up on their pet diseases and list down the questions and email to the vet.

I know that facebook and facepage are more popular. However, to succeed, I need to spend time updating regularly. I have focused on youtube and blogger.com.  

Pl send me actual links in your facebook and facepage as I can't access them.

Make a difference in being "kind to pets" when you are young. Share your knowledge in an e-book.

Best wishes

1188. Feline urethrostomy

https://www.youtube.com/watch?v=2KcuW-trvPI

1187. Kidney stones - Intense abdominal pain in an old poodle

Sunday May 3, 2015

The 12-year-old poodle is much loved. 2 years ago, she had a bladder stone removed. I advised that the few specks of stones in the left kidney can be dissolved by S/D diet. However, the owner did not come for reviews for the next 2 years as the dog was fed home-cooked food. The left kidney now has large stones.

Kidney stones do occur in dogs but are rare compared to bladder stones. In this case, the dog was free of blood in the urine for 2 years after removal of the large bladder stone. I had advised S/D diet to remove the few specks of stones in the left kidney (as seen in the X-ray).

I did not do hard sell as this may antagonise the owners.  The owner did not follow up after bladder stone removal for the next 2 years. Now the dog has acute abdominal pain and kidney failure. Singapore does not have the machine to break down the bladder stones using sound waves and in any case, it would be very expensive. The dog was in great pain and had kidney failure. No operation to remove the left kidney is advised as the dog would die on the op table.

In retrospect, if the owner agrees, the dog would be on S/D diet for 3 months. X-rays and urine test. 

1186. The 13-year-old Beagle X has diarrhoea many times for the past 4 days

Sunday May 3, 2015

"His right eye has pus and is very red," the young man said. "He has diarrhoea 3-4 x/day for the past 4 days!"

The old Beagle had circum-anal tumour removed by Dr Daniel some 3 weeks ago. He did not come back for neutering as the male hormones could cause a recurrence of the circum-anal tumour.

"Could the tumour cause the diarrhoea?" the young man asked.

"It is possible if it is cancerous and has spread into the intestines," I said.

"I would like the tumour tested for cancer."

"It is too late as you did not want it tested after surgery as we don't keep it."

"What is the cause of diarrhoea?" the young man asked. "We feed the same dry dog food,"

"The dog was boarded earlier than 4 days ago and could have eaten other food upsetting his stomach. It could be viral infections from other dogs in the boarding house, causing gastro-enteritis."

The dog would be given IV drip, antibiotic and anti-diarrhoea for the next 24 hours.

1185. An investment banker's Schnauzer keeps scratching ears non-stop

Saturday May 2, 2015

"It is the cost of the ear surgery," the investment banker had not turned up for the surgery in 2014. The dog had frequent head shaking and ear scratching for the past 2 years. So he brought the dog in for treatment of ear irrigation and medication. I explained to him that the best solution would be to do ear surgery to open up the side wall of the ear canal. 

This Schnauzer has very hairy ear canals and so there was no drainage and ventilation. The continuous scratching and vet treatment over the last 2 years added up and would cost more than the surgery.

I showed him the video of a Schnauzer after ear surgery at:
  https://www.youtube.com/watch?v=tQKGWCS-mzo&feature=youtu.be

"The Schnauzer needs some maintenance of the horizontal ear canal when his ears feel itchy," I said to him. "But there will be much less scratching every time, causing ear swelling and pain."

An appointment for surgery is made on May 12, 2015 and this time, the banker intends to keep the appointment. It seems like a hard sell to advise ear surgery. It seems expensive at $900 for 2 years at this time, but I advise surgery when it is needed by the dog to save the dog many weeks of head shaking and ear scratching. In some cases, chronic otitis externa lead to infections of the middle ear and head tilt after the ear drum had ruptured and bacteria goes into the middle ear. It will be too late.