Thursday, July 7, 2011

492. Sixteen-year-old Maltese X with pyometra - euthanasia or not?

Sunday Jul 3, 2011

I thought this Sunday would be an uneventful Sunday with the usual veterinary conditions seen throughout the years.

I would work half a day and take the afternoon off. Then I would watch the movie "Jane Eyre" at 7 pm at the Shaw Lido cinema. Suddenly a young worried-looking young man in his early 30s and a lady came with a very thin Maltese passing pus from her vagina for the past 5 months. They had consulted my associate yesterday, Dr Jason Teo had given an anti-fever and antibiotic injection yesterday as the dog had high fever. However, she had no fever now.

"What do you advise?" the sister asked me. "Do you recommend euthanasia?" This was a very old female dog. Very thin and weak and would be a very high anaesthetic risk.

"It is up to the owner as to whether he wants to euthanase this dog or not," I replied. "I don't advise euthanasia or surgery. It is up to the owner as surgery has a high risk of death on the operating table for this very old dog. In human years, she would be over 100 years old!"

The young man was hesitant. "Please think it over," I said. "You may not see this dog alive once she enters the operating table."

To euthanase or not? As long as there is life, there is hope. It does not mean that a very old dog that is in very poor health will definitely die on the operating table. It is just that the probability of dying is over 90% in this case.

"In pyometra cases, there is no choice but to operate. Much depends on economics," I advised. "Pyometra surgery and anaesthesia will cost around $1,000 as it takes a longer time as compared to a normal spay which is much cheaper."

The young man could not decide. I said: "Please wait in the reception room and think about the surgery." Why did he wait for over 3 months of the dog passing pus in the vagina to seek treatment, I did not ask him. Most likely, he anticipated that the dog would die on the operating table and therefore procrastinated till the dog was very thin and unable to eat.

I don't relish operating on high risk dogs as I do get emotionally affected whenever a dog dies on the operating table. For whatever reason. Some 40 years ago, I would have advised euthanasia as that was the prevalent thinking of my baby-boomer generation. Not much hope of survival. So why spend money on doing surgery? Save the owner some money. The vet who advises euthanasia for very sick dogs becomes despised and deemed uncaring and incompetent.

This type of advice does not resonate well with the younger generation. So, nowadays, I let the owner make the final decision of euthanasia or surgery in serious pyometra cases of old dogs. This case would be my second case of a very old dog past 15 years of age, suffering from pyometra. There are only a handful of such such cases seen by me in my 40 years of practice and the other case was deemed a success.

Yet one swallow does not make a summer. I did not want to operate. Yet euthanasia would be unacceptable for me too. This would be a very high risk surgery. Why risk my reputation?

The young man finally said: "OK, do the surgery." He did not want any blood test to be done.

Below is the account of the surgery, anaesthesia and follow-up.

ANAESTHESIA
Isoflurane gas at 5% given by mask. No sedation. IV drip.
Intubated and give gas at 1-3%.

The dog was given just sufficient gas but this was insufficient to bring her deeper into surgical anaesthesia. The dog kept moving and I would stop the surgery while she inhaled more gas. This method prolonged the surgery which started from 10.50 am and completed at 11.35 am on this Sunday. In normal pyometra dog anaesthesia, the dog would be fully anaesthesized and the surgery could be completed in less than 30 minutes.

But this was a very old dog and life and death depended on the anaesthetic skills of the vet. My assistant Min wanted to increase the isoflurane percentage to 5% to get a deeper anaesthesia. "Don't do it," I told him off. "She is a very old dog and normally 2% is sufficient in normal dogs. Just wait a while at 3% maximum. Old dogs die when given 5% for some time as she is in a very unstable anaesthetic stage."

After removal of the womb and ovaries, the dog's anaesthesia was excellent.

SURGERY
"The blood is bright red," I said to my assistant. "It is a good sign as toxic blood is usually dark blue due to lack of oxygenation." An unusual bright red in this case as compared to the cyanotic blue of another case in a Golden Retriever I operated in 2008 (see hyperlink).

There are three significant aspects of this surgical case.
1. Cysts and swelling in parts of the uterine bodies, indicating a partial rupture of the uterus and spilling of the toxic pus into the abdomen.

2. This is shown in a very thick peritoneum of 3 mm thickness. Normally, the peritoneum is thinner than 1 mm. So, there was peritonitis.

3. A grossly swollen vagina and cervix was seen. I did not get a photo taken as I was in a rush to complete the surgery which was taking too long due to an unstable anaesthesia. This is extremely rare. Was there a tumour inside the vagina? Was there an abnormal hymen? I don't know. I put in 3 ligatures to prevent the pus from the vagina from leaking into the abdomen as I removed the uterine horns and ovaries.

BLEEDING. Lots of bleeding from the omental blood vessels which were fragile. Probably a result of cystic ovaries producing abnormal amounts of hormone. I checked carefully that there was no major blood vessel from the uterine body haemorrhaging as I had 3 ligatures around the uterine body. I swabbed off the blood.

SUTURE
After 3 ligatures of the uterine body, I closed the muscles with a continuous suture 2/0 absorbable. Normally, I don't bother with continuous sutures but just use simple interrupted sutures and I find that fine. After the continouous sutures, I stitched another 3 interrupted sutures. The skin incision was stitched horizontal mattress sutures as these hold well and are not easily licked off unlike interrupted sutures, in my experience.


POST-OP
The young man insisted on taking the dog home to nurse by himself. He was not experience in post-operation nursing. If owners are insistent, I would ask them to sign a discharge form saying that they want the dog discharged against medical advice. However, he agreed to let her rest overnight at Toa Payoh Vets and get the necessary drip.

POST-OP NURSING CARE DAY 1-3

1. Vomiting.

"The dog vomits when I feed her very small amounts of the A/D canned food and water," the owner phoned me on Day 1 and 2. I advised feeding separately at 6 times per day but he said the dog would vomit after a while. "What's the cause?" he asked. "My dog does not vomit before the surgery."

"It is hard to tell you the cause," I said. "You did not want blood test. It could be stomach ulceration due to kidney disorders and uraemia. Or liver disorders. It could be gastritis or any other reason."

2. Fits on Day 3.
On Day 3, the owner phoned me saying that the dog had a few seconds of fits. "What's the cause?" he asked. "It could be due to low blood sugar or kidney disorders. Come for an IV drip and review."

After dextrose saline and amino acid drips, the owner took the dog home with another bottle of drip which he would administer himself.

3. Day 3 - Day 6 (today). No more vomiting. The owner was told to feed the canned food and the multi-vitamin paste but not to give water. I had given a Baytril antibiotic and anti-inflam pred injection with the drip on Day 3 when he came for the fits.

CONCLUSION
The dog started to eat by herself from Day 3 to 6. That was good news. I advised giving water in small amounts at different times. So far, so good. This is one of my most unusual cases. As for the vulval swelling of 30x, I told the owner that the swelling had reduced by 80% on Day 3 when he came in for the review of fits.

The road back to good health is long. This is one of the rare cases where the owner does not opt for euthanasia as most will do so.






More pictures are at
http://www.sinpets.com/201006265pyometra-16years-MalteseX-swollen-vagina-toapayohvets-Singapore-ToaPayohVets.htm

Wednesday, July 6, 2011

The hamster caring younger generation of Singaporeans compared to the baby boomer generation

On Jun 8, 2011, I attended the SAP Summit 2011 - The Future State. The 9.10 am topic for the panelists was "The Secrets of Making A Best-Run Government Run Better; The Changing Mandate; The Shocking Disasters; The Future State

The Panelists were: Dr Anthony M Cresswell, Deputy Director, Center for Technology in Government, University at Albany, NY, USA; Zaqy Mohamad, Member of Parliament, Choa Chu Kang GRC, Singapore and Adaire Fox-Martin, SVP, Industry Business Solutions, SAP Asia Pacific Japan.

Mr Zaqy spoke about the better use of social media by politicians to engage the segment of the public. Apparently this had not been done effectively in the recent General Elections in Singapore if I heard Mr Zaqy Mohamad correctly.

The other panelist, Dr Anthony Cresswell talked about President Obama's Open Government's initiatives in the US and the difficulty of evaluating the key performance indicators of the services provided. It was an eye-opener for me when he said that over 80% of government computerisation projects fail.

What is the relevance of social media to veterinary surgeons in practice? There is a segment of the pet owners who are younger and would only be engaged through the use of social media. They will search for topics of relevance to their pet's illness and want to know which vet has the ability and experience to treat their beloved pets. Their own vet may not provide such a service.

Social media using webpages or blog requires the content to be created daily. There is now the twitter novel (short novels of 140 words are popular with netizens of China). Whatever the form, the contents must be updated daily or weekly to get a stream of "fans". Writing is very hard work for those who prefer not to touch a pen as there need to be research to produce a useful article. There are so many distractions and better things to do than to create good content after a hard day's work at the Surgery!

To illustrate the amount of work involved to produce a useful article, I will let readers know how I produced the article, "What Makes A Horse Racing Club Profitable?" This article was written in 1989 and the scanned pages are at Horses, starting with the first page at: http://www.asiahomes.com/dev/Stc1.JPG

CASE 1. The hamster with a very large ear wart
On a recent encounter, 2 days ago on Jun 9, 2011, I met an aunty and her niece who brought a hamster with a large dangling ear wart to Toa Payoh Vets. This wart was initially very small but her vet said she would not operate due to the high anaesthetic risks. As the wart grew bigger over the last 4-5 months, her vet referred her to another vet whose location was quite far to her residence. So this aunty googled for "hamster, warts" and an asiahomes webpage, probably similar http://www.asiahomes.com/singaporetpvet/ popped out.
I was at the Surgery at that time and so I got the above-mentioned feedback from her. This episode demonstrated the culture and lifestyle of the younger generation. The aunty was around 30-40 years old. The niece was a teenager. I paid special attention to this case as I collaborated with Dr Vanessa to ensure that the outcome of anaesthesia was what the aunty hoped for. Signing an informed anaesthesia consent form is one thing. I don't usually request it but Dr Vanessa does.

What was important was that the hamster come out of the surgery room alive and biting (this hamster bites, the aunty had said). Obviously, I would bite if anybody messes around with my wart. The hamster was anaesthesized under isoflurane gas.
A good anaesthetic assistant is invaluable. However, he or she needs to be trained as vet schools don't teach much about hamster anaesthesias. I kept a close eye on my assistant Mr Min telling him not to be distracted by looking for sutures etc while anaesthesizing the hamster. At one time, his eyes and one hand were on a drawer to take out a packet of suture for Dr Vanessa Lin.

I told him off not to do it. "Hamsters die because there is no 100% focus on anaesthesia by one person or the vet." It is important that new vet assistants and new vets need to be mentored closely in hamster anaesthesia and surgery as such cases are high risk anaesthetic cases.

There is no other way to prevent anaesthetic deaths in hamsters when the vet does hamster anaesthesia. Deaths on the operating table damages the reputation of Toa Payoh Vets and I am very strict on anaesthetic training and procedures to ensure that no healthy pets should die on the operating table at all times.

Dr Vanessa Lin excised the wart and sutured the wound. I proposed no suturing as the wound in the ear was so small and that bleeding would stop with pressure. As each vet has his or her own ideas, I will not interfere whenever an associate vet operates in most cases but I do monitor the handwork - the post-operation complications and the complaints. This is my duty of care for Toa Payoh Vets clientele.

She decided to stitch up the wound. I recommended potassium permanganate to stop the bleeding. Each vet has his or her approach to a surgical case and there are several satisfactory outcomes on any approach. Bleeding still came back as I had predicted in this case. This bleeding was not life-threatening.

The hamster was now free of "shouldering" a burden. Actually, the wart of 1.5 cm x 1.2 cm x 0.5 cm looked so much like one of those big dangling ear rings worn by some ladies. The hamster scratched his left ear where the wound was. The aunty was concerned. So I proposed a paper e-collar. "The hamster hates it very much," I said to the aunty as she put the e-collar on. The hamster used all his two hands to pull out the hamster. Vigorously and angrily I think. So, no more e-collar. "Just use the clean tissue to wipe off the blood," I advised the aunty. "And take the medication." The niece did not say a word but I presumed she was the real owner of this beloved hamster and was happy.










P.S. What are the Secrets of Making A Best-Run Government Run Better? There were no clear list of secrets enumerated as far as I know. The political party who knows how to engage the Generation Y effectively will be the one to win their votes and get the increased mandate to govern if the Generation Y is the vote swinger. The Government is now said to be a business. So, the Government who provides "public value" to the citizens will be a better-run government. 
CASE 2. The hamster with a small ear wart
On Sunday July 3, 2011, I visited a hamster, rabbit, guinea pig and chinchilla pet shop after work at 6 pm. It was a busy Sunday working together with Dr Vanessa Lin.

The pet shop owner, Agnes asked me: "Many hamsters develop tumours after one year of age, according to my customers. Do you see many cases" I said: "Yes, I do see some cases and tumours do develop in most hamsters after one year of age but they can be excised if they are small."

Agnes said: "The hamster owner thinks that he or she can buy 10 hamsters rather than paying the veterinary fees. So, some don't bother. I suppose that even if the fees are $50.00, such owners will not send their hamsters for surgery."

Agnes is licensed to sell dwarf hamsters and each costs $12.00. As Singapore develops into a modern society, there are many caring hamster owners who do want their hamster tumours to be excised by the vet. Some wait too late as they hope that the tumour will disappear or they are just too busy to go to the vet. Some are poorly advised by their own vets to "wait and see" after taking "medication."

Many vets all over the world do not like to perform surgery on hamsters as they die easily as it is extremely difficult to monitor the stages of anaesthesia unlike in the case of the dog and cat.




Be Kind To Dwarf Hamsters. Get your vet to excise his ear wart when it is very small as in this case compared to the hamster with a large ear wart. Smaller warts cost you less to remove as they take shorter time and do not usually require stitching.
CASE 3. The hamster with two large chest tumours
Anaesthesia in this Syrian Hamster in Jun 2011
The Syrian Hamster was very thin. I could feel the spines. So I told the owner that I would give oral antibiotics and electrolytes for 24 hours at 3 times before anaesthesia and surgery. This hamster had stopped eating as was evident in no stool production.

I told the owner orally that the anaesthetic risks were very high as the hamster was not in good health. She understood the risks. This communication should be recorded in the case sheet and informed consent form should be signed in theory.

There are at least two methods of anaesthesia in this case. Isoflurane gas alone is the first method. However I find that this surgery can be better performed if the hamster is sedated by Zoletil so that less gas anaesthetic is required and I do not need to place him into the gas container every few seconds. It would be a very painful surgery as the lumps were massive and there were two of them.

I used the 2nd method of Zoletil sedation and topping up with isoflurane anaesthesia gas. I took out a new bottle of Zoletil 100. A 5-ml diluent is advised to make up Zoletil 100. However, I added 10 ml diluent so this would be Zoletil 50. I injected two drops IM. This dosage would not be sufficient from my experience but this hamster was not healthy and that was why I reduced the dose. It is very hard to know exactly the dosage that would not kill the hamster. A healthy plump adult Syrian hamster should have no problem with
4 drops of Zoletil 50 IM but this hamster was skinny as a rake.

OBSERVATION AND CLOSE MONITORING
"Count up to 10 and take the hamster out of the container," I said to my assistant whenever he put the hamster inside the plastic container of 5% isoflurane gas. He was not used to such instructions as he had little experience of hamster anaesthesia. My job is to train him up to assist all Toa Payoh Vets in hamster anaesthesia and receiving excellent outcome. Only with excellent clinical outcome and not anaesthetic deaths do the vet get referrals.

Mr Min felt it stupid to count as he graduated as a vet from Myanmar where I presume hamsters were not part of the veterinary studies. Even talking to dogs while giving injections is alien to his culture. Finally he counted: "1-2-3-4...10". He took the hamster out and I continued with the excision of over 3 cm long. The hamster gave a squeaky sound and I put him back to isoflurane gas container to get anaesthesized. On and off. Finally, the surgery was completed and the hamster woke up. He was OK and went home 48 hours later with no complaints.









4267 - 4275. Massive tumours in a Syrian hamster
CASE 4. Was it a bruised area or a chest tumour?
The vet is ultimately responsible for the deaths on the operating table. Extremely close monitoring of the stages of anaesthesia is very important in hamster anaesthesia as the eyelid and pedal reflexes are impossible to do unlike in the dog and cat. A bit more gas. A distraction of a few seconds. Cold air-conditioning air. Dampness and wetness. The hamster just dies on the operating table. It is indeed a very stressful anaesthesia and surgery when large massive tumours are presented.

Morally and ethically, it is best for the vet who does not want to handle hamster tumours, to reject the case outright rather than to prescribe the owner some medication and advise "wait-and-see" when they present hamsters with tumours (hard, firm lump). Just ask the hamster owner to seek another vet rather than give false hopes of recovery from oral medication. I can understand that vets may not wish to refer to competitors who may not be competent and if the hamster dies at the competitor's place, there will be blame on the referral.









4283 - 4290. HAMSTER PATIENT. Roborovski's tumour was discovered when the hamster's nose got bruised due to traumatic injury. "Is it due to the bruise?" the owner asked her vet. "Yes," the vet said. Within two weeks, the growth exploded to a gigantic size and was not operable.
Many caring hamster owners are from the younger generation of Singaporeans and are well educated. They are also quite sophisticated in knowing that oral medication for tumour cases are a waste of their money. Not only that, this act delays the owner from seeking early veterinary surgery for the removal of the tumour, some of which may be fast-growing malignant tumours.



Pictures are at:
http://www.sinpets.com/F6/201006255government-social-media-veterinary-ToaPayohVets.htm

490. Personalised match-making course in Singapore by Toa Payoh Vets

One of my interesting client is working in the Singapore match-making agency called Social Development Network (SDN), Ministry of Community Development, Youth and Sports.

The SDN has a new strategy whereby it partners "grassroot organisations" to do match-making. This is an excellent idea as the communities are a great source of contacts. I wonder whether Toa Payoh Vets can be a partner of the SDN. For example, introducing pet owners to pet owners via functions organised by Toa Payoh Vets in partnership with the SDN? Do I sound desperate?

The young lady sent me a list of courses in match-making. Everything in Singapore seems to require government approval, training and certification. So that is why I asked her to give me a list of training courses. I have included the list in my blog in case some of my readers may be interested.

Below is my e-mail reply to her.

E-MAIL FROM DR SING DATED JULY 6, 2011

Hi

Is your cat's breathing rate normal now? I have not heard from you for the past 3 days and presume she is OK now.

Thanks again for dating agency courses. I wonder whether there are any baby boomer attending the "personalised dating service" courses? Such courses may be good for veterinarians in providing "personalised veterinary service" as client-doctor relationships last a life-time and into the younger generation if there is an element of connection and trust.

The following true story may be of interest to your lecturer. I had this enterprising realtor friend in his 50s. He can sell ice to Eskimos as that is his personality and he does not have the fortune of being a graduate. He sold me an idea to invest in his Hainanese businessman's pig farming business and spent his time and money to take me on a tour of the three big pig farms. I enjoyed the pig-farm tourism as I was once a pig vet in Singapore in the 1970s when I was a newly minted veterinarian working for the Primary Production Department (now called Agri-Food & Veterinary Authority).

Once I asked this man whether he had done any dating business in Hainan since he has the connections in Hainan. He actually did one successful personalised match-making a lady from his hometown in Hainan with a Singaporean free of charge. He is very welcome by the Hainanese mothers in his home-town. I was surprised.

He told me that it is a very risky venture as he will be blamed if the marriage fails later and so he has stopped doing it. "The best income still comes from property,"he said to me recently. "But not selling properties to Singaporeans." Now he sells Singapore properties to his China quite successfully and if you think about it, China is a vast market of possibilities in real estate and in match-making.

Best wishes.


INFORMATION
List of Accredited Dating Agencies:

http://app1.mcys.gov.sg/Policies/DatingIndustryServices/RegistryofDatingAgencies.aspx



Course details for Organising a Dating Event:

http://www.ssti.org.sg/Programmes/ProgrammeDetails.aspx?Programmes_ProgrammeDetails=%201|SC005335



Course details for Provide Personalised Dating Services:

http://www.ssti.org.sg/Programmes/ProgrammeDetails.aspx?Programmes_ProgrammeDetails=%201|SC005307



Course details for Establish and Manage a Dating Business:

http://www.ssti.org.sg/Programmes/ProgrammeDetails.aspx?Programmes_ProgrammeDetails=%201|SC005307

Tuesday, July 5, 2011

Flesh-rotting bacteria from a hamster bite wound

E-MAIL TO DR SING DATED JUN 30, 2011

Dear Dr. Sing,

I have called in earlier to make an appointment. The patient is a 14 month old Syrian hamster, Quickie who has this abscess near her left arm. The abscess was formed after she was bitten by another syrian hamster and the abscess have since ! then emitted this pungent odor. Quickie have lost some weight ( compared to the picture of her on the bed) although she still does eat.

Meanwhile, Quickie no longer runs on her favorite wheel like she used to. I would like to seek your advise on how to prepare her for a surgery and is there a possibility that Gangrene or Necrosis has occurred due to the pungent odor? In the meantime, what will be the estimated cost of her surgery and what are her chances of making it through the surgery.

E-MAIL REPLY FROM DR SING DATED JUL 3, 2011
Pl accept my apology for the late reply which I read during the day your hamster came. The lump was large and full of dead cells and small tumours as well as the strong rotten smell of flesh. Therefore at least 3 cm of the skin incision had to be done.


4276. Three hamster patients waiting to go home




4277 - 4279. Syrian hamster bitten by another. A flesh-rotting bacterial infection forms quickly.
Pl do not forget to give the hamster her antibiotics as the bacteria is a type that produces bad-smelling gases. She may need stitches to be removed in 14 days if they don't dissolve by themselves at that time.

Best wishes.
- Show quoted text -


E-MAIL REPLY TO DR SING DATED JUL 4, 2011
Dear Dr. Sing,

I have fed her antibiotics and the Biolapes (the packet of powdery med. which was mixed with 50ml of water and fed at 0.5ml twice per day, did I get this right?) Anyway, I came down to the clinic earlier to get another syringe of Prednisolone as I spilled it while feeding her the other day. This vet Vanessa attended to me and told me that it would not be advisable to feed her that as its a kind of 'steroid'.

Thus, I am writing to you to confirm the dosage again. While Quickie is getting better, as she do get up and walk around and eat.. I am pretty worried about the wound as I can still smell a little bit of that odor although there are no longer any signs of bleeding. However, Quickie kinda 'urinated blood' but no longer do anymore. Why is this happening?

Thank you very much Dr. Sing, Quickie means a lot to me and I am really thankful for your help.


E-MAIL REPLY FROM DR SING DATED JUL 5, 2011
Best to telephone me direct rather than text as medical queries are best answered directly as text messages may be mis-interpreted.

As every vet has his or her own treatment based on many factors especially practical experience over the years as compared to the academic teachings of professors to recent veterinary graduates, the rationale of using drugs such as prednisolone which is a steroid in your hamster post-operation, is best explained to you, the owner, directly by phone.

As for passing "blood", the colour of urine is due to the pigments from the hamster grooming herself of blood stains post-op. being absorbed and passed out in the urine. If there is still smell in the wound and you are concerned, please bring the hamster for review as your case was a bad case of flesh-rotting bacteria multiplying inside the wound due to hamster bite.

Please feel free to contact me by phone or make an appointment to see me. I consult usually in the mornings, except on Saturdays but may be available in the afternoons sometimes.

I don't usually reply by text via my phone when detailed explanations are required as in this case.

UPDATE AS AT JULY 5, 2011 5 PM
July 5, 2011. The young lady returned my call at 5 pm. Her hamster is OK and eating selectively. "My hamster is not biting the stitches. She can't reach it." the lady said. That is good news. However, the hamster can always rub against some areas if it is itchy and the stitches will break down.

"There is a faint bad smell in the hamster," she said. I advised: "Take a piece of facial cotton. Wet it in warm water. Then wipe gently the surrounding skin as the rotting flesh smell had stained the skin and it was not possible to wipe all away during surgery. Use another piece of cotton to dry up the area."

As regards prednisolone, I told her (and also Dr Vanessa Lin in my Surgery) that a very small drop/day (around 0.001 ml of 5mg/ml) for 7 days will help the hamster to feel less painful, promotes appetite and prevents stitch biting, from my experience.

"All vet students have had been warned by their professors not to use 'steroid'" post-surgery and in infections and so all graduate with this warning, including myself who graduated some 40 years ago," I said to Dr Vanessa. The professors have their theories but in practice, the realities of the hamster ripping off its stitches are horrifying and costly to the hamster owner.
As regards stitches dissolving, I told the owner that the stitches will dissolve and drop off usually after 14 days. If not, she has to come for stitch removal.

The young lady will not house her hamster next to each other, separated by a grate, anymore.

Pictures are at: www.toapayohvets.com, goto HAMSTERS

488. Golden Retriever peeing problem

Hi Dr Sing,

I am having some paper training problem with my 4mth male Golden Retriever puppy and hope to get some advice from you.

My puppy is call Wangwang and he had been with me since 2.5mths.
It took us 2 weeks plus to paper trained him to pee n poo on newspaper which we placed in the kitchen area.
He had been doing so for abt a mth.

However recently, he begin to sometimes pee in the living area and other areas.
Which means, sometimes he will pee on the newspaper (n tats usually in the morning) but other times he will pee elsewhere.
He still poo on the newspaper thou despite his peeing problem.

Another thing we notice is that he tends to 'leak' pee when we touch him.
There is even once he pee out when we are giving him belly rub (ya he pee when he is on his back like a fountain)

Is it because he tend to hold his bladder till very full and is unable to control till he reach the newspaper? There are a couple of times i saw him running into the kitchen n just pee half way before he can reach the newspaper at the corner.

Wang wang knew he had done wrong by peeing elsewhere other than the destinated place because everytime he mis-pee, he will quickly hide under the chair.

Is he getting restless thus the misbehavior or is there anything wrong with his bladder?
I will really appreciate your advice in Wangwang's change of peeing habit.

Thank you so much

Best regards,
Name of owner

E-MAIL REPLY FROM DR SING


I am Dr Sing from www.toapayohvets.com. Thank you for your e-mail.
There are at least 3 possibilities for your dog's actions
1. A urinary tract infection. Get your vet to have his urine analysed.

2. Submissive urination. Pees when his belly is rubbed. Don't continue with your rubbing. Don't greet him with a loud tone when he sees you. Build up his confidence. More socialising and outdoor experience. Read books on submissive/excitation uirnation.

3. Unknown causes arising from your management and housing.

In any case, a veterinary examination soon is advised.
- Show quoted text -

Monday, July 4, 2011

487. Can two canine minds communicate and call out to each other through space and time?

June 30, 2011 was a day to remember. Slightly downcast. The last day of the month and the day Dr Vanessa Lin returned from her leave while undergraduate Shirley Lin would be completing her last day of work. A phone call came from the 2nd owner of the 4-year-old male Jack Russell. "My dog had died. What should I do?"

I made the necessary cremation arrangements. Nothing particular about a dog dying, you would say.

Sunday, July 3, 2011

486. A rare case of pyometra in a very young Silkie Terrier

CASE 1. PYOMETRA IN A 10-MONTH-OLD SILKIE
I advise 2-3 months after the end of heat as the best and safest time to spay the female dog. There will be less bleeding as the blood vessels are not enlarged as shown in the two cases below. The Silkie Terrier has an infection of the womb, medically known as pyometra. Pyometra is rare in female dogs at 10 months of age and is usually present when the female dog is over 5 years old.


CASE 2. OWNER'S INSPECTION BEFORE HER CHOW CHOW IS SPAYED BY THE VET
In the Chow Chow, I have taken pictures of the inside of the Toa Payoh Vets' operation room in 2010 as some of the younger owners, such as the Chow Chow owner, are interested as to where their dog is spayed. The young lady came one late evening in July 2010 when I was still around and asked to see the Operation Room and the Hospitalisation Area. I showed her and she brought her Chow Chow in for the spay later.

The room is essentially the same in 2011 except that I have replaced with brand new sets - the isoflurane gas machine, the oxygen regulators and a new veterinary operation table. The Operation Room has a glass partition to bring in natural light. So, there is an incorrect impression that hospitalised cats and dogs are inside the Operation Room! I got the glass partition from a pet shop owner who was wanted to dispose of it as he was renovating his shopping mall pet shop at the time I was re-modelling my Operation Room.
I wanted the glass partition for my front door but it was not fitting. Then I thought of having it as part of the Operation Room instead of a gypsum wall partition which would make the room claustrophobic. This glass partition made veterinary surgery much more pleasant as I could see the natural daylight from the back door which is open during the daytime.

As regards closure of the skin wound, each veterinary surgeon has his own favourite method. Mine is just one or two horizontal mattress using 2/0 or 3/0 absorbable sutures so that the dog owner does NOT need to come back 14 days later for stitch removal. I find that one packet os suture has sufficient length to spay a female dog of a large breed such as the Golden Retriever. The suture is used to ligate the two ovaries and the uterine body. Then 3 or 4 interrupted sutures to close the linea alba. After that 1 or 2 horizontal mattress sutures to close the skin. I don't use subcuticular sutures. With this method used over the last 20 years of practice, I find that there are no post-operation itchiness and licking in 90% of my spay cases.

Pictures are at:
http://www.sinpets.com/F6/201006261spaying-dogs-toapayohvets-Singapore-ToaPayohVets.htm