Saturday, June 18, 2016

2959. A cat is constipated and incontinent

Sat Jun 18, 2016

PATIENT:  TP 46680   Domestic short-haired, male, neutered, 6 years
Constipated for 2 months. Hard stools palpated.
Incontinent, leaking urine for 1 month
Vomits "hair balls" 4-5X/day

2958. A dedicated stray cat catcher in Singapore

Sat Jun 18, 2016

At 11.30 am, I met this woman in her late 40s,  wearing a CWS black T-shirt with the white words of "Trap, Neuter, Release, Manage. "  She has 3 years of almost daily experience of trapping the stray cats and sending to the vet for sterilisation. The cat feeders will pay her for the sending the cat to the vbet.  She shared her experiences.

CAT PSYCHOPLOGY
1. The traps come from the US. There are 2 types.
1.1  Long cage with food at the other end.  There is a long "tunnel" and many stray cats are cautious of the structure. The cat steps in and springs a trap door which closes down.
1.2  Shorter broader cage looking like a shelter with a transfer cage. These were present in her SUV which can accommodate 11 cat carriers.

"The trap door is at an angle on the top. So, the cat views it as a safe haven and enters the cage," she explained to me. "I will pull the rope to drop the trap door. "Must have good eyesight if your rope is very long and you are distant. There is a remote control but I don't trust it."


SMELL OF CAT FOOD
1. Good quality fish provided by some cat feeders. "The cat just will not eat it," she said. "The smellier the better and they are usually of lower quality and meant for stray cats. ."
"What brand you use?" I ask. 
"Aristocat. The bigger can. The cat just cannot resist it."

PERFORMANCE
1. 4-6 hours of work to trap 6-8 cats per day. The other stray cats get wiser and will not be caught.
"What to do then?" I saw that she was very busy with her passion of daily cat trapping although she has a job. 
"I come back another day."
"Will the cats be wary of you?" I asked.
"Cats are not so clever. They see the broad cage I use as a shelter and the strong smell of Aristocat will just be irresistible!"   

VET FEES
$30 to neuter a male and $60 for a female, excluding hospitalisation charges.
(CWS)

1.  "The CWS needs $20,00 per month to sterilise all the stray cats in Singapore," she said. "Cats can hide inside drains unlike the poor stray dogs and so there are many more every day." Her cat feeders pay for the vet fees.

I notice many fewer stray cats near coffeshops nowadays. I suspect that the government and the town councils and pest controllers have culled them by netting.  They are many hiding somewhere.



Thursday, June 16, 2016

2957. A 1.5-year-old male entire cat cannot pee- perineal urethrostomy.

Jun 15, 2016

Vet 1 had hospitalised and catheterised this cat twice and told the owner to come back if the cat still cannot pee. But the owner went to another vet who referred to Vet 1 for operation. The cost of perineal urethrostomy would be $3,000 but the vet was not free. She phoned other vets but they would not do the operation citing much post-op complications and complaints.

She phoned me. My fees were lower and the owner brought the cat to me. He had enlarged kidneys and azotemia as evidenced by Vet 2's blood test. I did an X-ray which did not show bladder stones. A perineal urethrostomy was done. The cat was warded for 3 days and went home. N

FOLLOW UP ON JUL 4, 2016
No complaint

2956. Incredible personal stories - 4 Caesarean kittens return from death's door

Jun 15, 2016

Yesterday, at 6 pm. Dr Daniel had Caesarean section and delivered 4 kittens, said to be 67 days old by the owner. Their toe nails were white and 2 mm long and the coat was thick. The kittens were wrapped up in shrunkened oily waterbag and did not move at all.

The first of the 5 kittens was born naturally at around 6 am. The owner phoned a vet who quoted $200 to $500 for a C-Section, but when he came to the clinic, the vet said it would be $1,000. Some unpleasant conversations led to the vet telling the owner to get lost as he was deemed "abusive".  Hewent home.

He called Toa Payoh Vets at around 5 pm and that was how the C-section was done. 

I had performed over 200 C-sections, mainly in breeders' dogs and had encountered such a situation of oily waterbags and dead puppies due to long delays in seeking C-section. So, there was no chance of recovery. Water had filled up the lungs and the kittens could not breathe.

As witnessed by the intern, a Seconday 3 student from CHIJ, Ang Mo Kio, I swung the kittens, pinched their neck skin and cleared their mouth and nostrils  of mucus.  Lots of water came out from the lungs when I swung the kittens in an arc for around 5 times/kitten. .

For over 15 minutes, my intern and I stimulated the kittens. 2 had faint gasps of breaths every few seconds and were not moving. But the other 2 were "dead". The gasping kittens would not pass away over the next 5 minutes and so we continued rubbing them.

Judy the assistant, came out of the op room, after the dam was stitched up and would rub their chest back and forth as they lay sideways. 

"The one with gasping will live," Dr Daniel took over after he had stitched up the dam. Time would have been over 30 minutes by now. Only one gasping kitten's body was warm. The 3, including the occasional gasping kitten were cold. The 2 gasping kittens would not pass away. I put their mouth into mine and blew in air to inflate their lungs. Many vets feel squeamish about such a procedure but it would save lives if the lungs had been cleared of mucus by swinging the kitten in an arc and seeing the mucus dripped out. 

Dr Daniel and Judy used a hair dryer to warm the 4 kittens. It took some 10 minutes.  
of more rubbing. A drop of adrenaline injection SC.

It is hard to believe. The 4 kittens were moving. So I got a video done to prove it. However, there was no video done before that and so, it is up to the readers to believe or not my incredible feline story of 4 kittens returning from death's door.


FOLLOW UP ON JUN 29, 2016
1. The natural born kitten died on the second day.
2. As at Jun 29, 2016, 15 days after C-section, only 2 kittens survived. The dam did not have much milk.
One of the 2 kittens had a right eye infection and the owner treated it himself. He sent me an image:





Tuesday, June 14, 2016

2955. A 15-year-old female Westie vomits many times in past 3 days




One year can make a great difference to the dog's health
as in this case




Jun 3, 2015
Not eating, vomited 2X in past 3 days
Heat 2 weeks ago. Milk present in mammary tissues.
Now pee many times as if urinary incontinent, pollakiuria and dysutria.

No abdominal or bladder pain.
Cystitis +/- pyometra. Advised spay 4 weeks later.



----------------------------------------------------


Jun 12, 2016
Not eating, vomited many times in the past 3 days
Heat 2 months ago. 

Lower abdominal and bladder pain.
Cystitis. No pyometra as white cells not elevated.
strong uraemic breath smell
lethargic. IV drips. Urea is very high and creatinine overshot the high range.

 

















Affer IV drip 2 bottles and medication, no more foul uraemic breath. But not eatring. Looks brighter.  Went home to do dialysis at home.












CONCLUSION
Kidney failure due to old age likely. Or chronic cystitis. No regular checkup after Jun 2015 successful treatment. Urea and creatinine levels were normal one year ago. But urine was showing protein 2+, blood 4+, white blood cells over 900, bacteria 2+ one eyar ago. Urine pH 7.0, SG 1.007. Also no crystals at that time. So there was cystitis one year ago.

Would this female dog have better chance of survival if spayed at younger age as open pyometra with bacteria going to bladder and kidneys in the past year is possibly a cause of kidney failure.


Saturday, June 11, 2016

1284. Update: An ear gangrene hamster and a ringworm hamster


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

Date: 12 February, 2013

Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
The hamster has a gangrenous ear and swollen nose Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 10 February, 2013
Date: 12 February, 2013
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2013-0131

Blog 1281.

Feb 10, 2013. Chinese New Year.
10 am to 1 pm

I opened the clinic for half a day on this Chinese New Year so that I could check on the sick animals, feed and clean up the kennels with my helper. My assistant Min had taken two days off and this would be his last month of work as he had another employer. Singapore is a developed country that is thriving and has low unemployment rates. This leads to employees job-hopping as a norm. The high rentals, manpower and operating costs are common nowadays resulting in businesses that can find difficulties in sustaining their operations. The vet must be hands-on as it is costly to employ more and more inexperienced staff who will job hop after a few months of experience. Other vets poach experienced staff and that is part of life and so loyalty of staff in Singapore is extremely rare in view of low employment rates.

The phone did not ring throughout the morning of Chinese New Year. I reviewed the severely dehydrated hamster with the ear gangrene and large nose abscesses operated yesterday at 4.30 pm. 17 hours after surgery. Would she be alive? She was less than one year old but from her hagged appearance with leg skin folds raised due to dehydration, I thought she was very aged. "This hamster has very little chance of surviving anaesthesia and surgery as she is barely moving and is severely dehydrated," I told the young lady who brought in this hamster on the eve of Chinese New Year. I lifted up the skin fold from above the neck and the skin fold did not shrink back as is did not have water unlike normal hydrated skin.

"You have two options," I said yesterday. "Euthanasia or surgery with a high possibility of death during or after surgery." The hamster was not eating or drinking as her upper lip was bursting with pus starting from the bridge of the nose towards the upper incisor teeth. In addition, two black gangrenous tumours filled up the right ear pinnae.

"She is less than a year old," the young lady said and picked up her mobile phone to dial. "I will ask my mum what to do." This was the last case on the last day of the old Chinese year and I did not want to end the year with a death of a pet on the operating table.

It was 4 pm and I would close at 5 pm to get ready for the reunion dinner at the Beng Tin Restaurant in Toa Payoh at 8 pm. The mum gave permission to operate.

"Why didn't you get the ear tumours operated by your vet when they were small and not black and gangrenous?" I asked the young lady. "There is now a very high chance of this hamster dying on the operating table."

The lady gave some reasons which related to a previous hamster having been sick and dying soon. "If there are bad news, can you phone us early in the morning on Chinese New Year?"

"No news is good news," I dislike deaths on Chinese New Year and here, there was a very high risk patient that could not wait for surgery as she was downhill in her health, being scarcely awake.

"I will give a 0.1 ml of dextrose saline under the skin now and operate soon." With a heavy heart, my assistant Min and I anaesthesized the hamster using 5% isoflurane gas inside a small plastic container. A few seconds of gas and the hamster was sleepy. I clamped a curved forceps on the right ear after ascertaining that the two gangrenous tumours were adhered to 80% of the ear pinnae and so there was no alternative but "amputate" the whole ear. After clamping for a few seconds, I sliced off the ear and unclamp the forceps. Surprisingly, there was no bleeding. My joy was short-lived as a large gush of red blood flowed as if a dam had burst. There was a 4-mm gap in the skin where the ear had been cut off and the blood vessels were hemorrhaging a few seconds after ear surgery.

Speed was of the essence in this hamster as she would not survive too many bouts of gas anaesthesia. I incised the two large yellow abscesses above the bridge of the nose. Thick yellow pus seeped out. There was pus at the upper lip which was much swollen. The abscesses seemed to be only on the right side of the nose, as if the hamster had been scratching and scratching over the past weeks to get rid of her painful gangrenous ear tumours. In the process of traumatising the right side of the nose by scratching, bacteria attacked the inside of the skin and formed two big swollen abscesses. This infection spread to the upper lip and it eventually stopped the hamster from being able to eat and drink. Severe dehydration set in.

After draining the abscesses, I decided to stitch up the ear wound and the abscesses with fine 6/0 sutures. The hamster was too weak to object. Two interrupted sutures closed up the ear wound and two closed up the nose wound. I cleaned up the red blood swamping the whole face and neck area. There was nothing more to be done as it is not possible to give an IV drip to such a small animal. A subcutaneous dextrose saline with baytril totalling 0.1 ml was given under the neck skin and I expected no hope of survival.

So imagine my surprise that the hamster was still alive 17 hours after the surgery when I checked her on Chinese New Year. Not moving but alive. This was a very tough cookie. The water bottle had leaked and the hamster was wet. She had hopped onto the food bowl to avoid the damp litter. Water bottles for hamsters are of poor quality and I had changed several. I quickly dried the hamster and put her on dry towel tissues. I gave her the eye drops as her eyes were shut and the medication orally.

5950 - 5956.
Ear gangrene
February 11, 2013. Chinese New Year 2nd day.

I opened the clinic from 10 am to 5 pm but I believed most vets closed for the 2nd day. Most Chinese pet owners would not seek out vets unless they had no choice as they would be busy visiting friends and relatives, exchanging Mandarin oranges and the single ones getting ang pows (red packets). Some vets would be on holidays overseas as they could take 3 days off and get 9 days of holidays as Chinese New Year's Eve started on a Saturday (February 9) and most employees would be off on the following Monday and Tuesday. One vet in Jurong West closed for 7 days and employees would be most happy with such good employers. A pet shop in Toa Payoh closed from February 8 to 15. There was no hunger or need to open during the Chinese New Year holidays for most businesses as employees must be kept happy or they work elsewhere.

Back to the tough cookie hamster. She was seeping water from the new water bottle for some time. I could hear the "click, click, click" sounds as she put her less swollen upper lips to sip the water. I videoed her drinking from various positions.

This was a good sign that the hamster was recovering well. Yet she seemed to take so many seeps. I checked the water bottle's nozzle. Was there any water coming out? The previous one was licking and this one seemed to be dry. I pressed the ball inside the nozzle and water seeped out onto my fore finger. There was water but there could be a temporary obstruction by the ball inside the nozzle. Finally the hamster had her drink.

I phoned the young lady to take her hamster home. She was most happy that her hamster was still alive. "I have to go visiting relatives and friends," she said she would bring the hamster back on the next day.

A dwarf hamster with generalised ringworm.
On this February 11, 2013, the second day of Chinese New Year, there was another dwarf hamster patient to go home. He had come in to see me as he was scratching his armpits and shoulder bare of hair. I had given an anti-fungal wash some 4 weeks ago but the hamster was still scratching and so I hospitalised him for clipping and review as there was a ringworm infection. On Chinese New Year's eve in the morning, I went to Chinatown to buy the small hair clipper ($35 battery operated, made in China). The previous one was not well maintained with cleaning and oiling and had rusted. It is extremely difficult to get employees including associate vets to take good care of the tools of the trade and so scratches on the $7,000 operating table and damages to scopes and the electro surgical equipment were common when used by a particular associate vet and vet assistant. As they don't have to pay for repairs and replacement, why should they bother?
I had this dwarf hamster clipped. He was very well taken care of because he was plump and had a very thick coat of several cm long. He was one and a half years old and he was more active than a 6-month-old dwarf hamster, zipping here and there inside my box. I had to sedate him to let my assistant clipped his thick coat as he would never permit the clipping. I videoed this clipping and the subsequent bathing by me to get rid of as much ringworm on the skin as possible. A few bald spots on his skin could be seen after clipping bald. The European couple loved him very much, especially the lady who could only communicate with me in English via her male friend. I prescribed some anti-fungal medication for 14 days in addition to the twice weekly baths of anti-ringworm solution. The European lady fed the hamster a white cloudy food like yogurt and the hamster licked greedily as if he had been in prison for a long time and deprived of his good food. "What is the food?" I asked. "Cheese," the male friend said. So this was one reason the hamster was so solid and had such a thick coat. Like a panda bear with a thick coat.

"Do you know there are two warts on the right front and back toes of this hamster?" I asked the couple. "They would be viral warts and ought to be removed when they were much smaller. One of them is yellowish as if there is an abscess."

"They were there for a long time," the man said.
"Now, they are bigger, more than 3 mm in diameter for the front paw tumour," I said. "In time, they would be very big as the hamster licks them."
"Will the hamster die if you remove them (under anaesthesia)?" the lady was most concerned.
"No," I said. "But I would need to remove the whole digit now as they cover most of the digit."
The lady was most distressed as she thought I meant the whole paw would be amputated.
"Think about it," I said. The couple brought the hamster home today and gave me a box of chocolates as a present. Small warts on paws are easily removed but procrastination can lead to large warts necessitating the amputation of the whole digit or paw. As hamsters and people age, some tumours will recur in some of the population. Growing tumours which are not cancerous will take time to expand but it is best to get them excised early.

The 2nd day of Chinese New Year had a few cases of vomiting and diarrhoea in cats and dogs. A dog's nose was cut by the mother's knife. A very sick vomiting old cat was requested to be euthanased. Another cat was suspected to be pregnant as the owner sought advice from Dr Daniel. The owner had told him that he was not happy with a vet who did not know how long is a cat's pregnancy. "It is not easy for a new vet to remember every gestation period of every animal," I said to Dr Daniel. Human medical doctors only need to remember how long it takes a woman to give birth. Vets are supposed to know every animal on earth.

This was the 2nd day of Chinese New Year. I was most happy that two dwarf hamsters had their problems resolved and that I could deliver a service to the satisfaction of two owners, one from the eastern part of Singapore in Changi and the other one from the northern part of Singapore in Woodlands. Referrals come from successful outcomes and these are better than slick advertising strategies.

Case written 6.13 am, Feb 12, 2013, 3rd day of Chinese New Year.

Updates and follow up at webpage:
http://www.sinpets.com/F6/20130211hamster_gangrene_ear_abscesses_nose_toapayohvets.htm
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: February 12, 2013

Toa Payoh Vets

Friday, June 10, 2016

2954. A 62nd pregnant Corgi had an elective Caesarean section

Jun 6, 2016  10 pm. Arrived from Yangon by Silk Air. Informed the breeder of Corgis I was back in Singapore. He had asked me to stand by for his Corgi dam, 62nd day pregnant on Jun 7, 2016 and he might want a C-section. 


Jun 7, 2016  9am
I operated on this 62nd-day Corgi as she had no labour contractions. She had 8 live pups 8 months ago, C-section by Dr Daniel. The pups were farmed out as she had no milk. All 8 pups passed away, according to the breeder.

In this C-section, I excised 1 cm away from the previous scar of the first C-section at the uterine body, I got 4 live pups out. The 3rd pup had a placenta wrapped around it and took some time to be taken out. The left uterine horn had 2 pups and appeared to have twisted as I had great difficulty milking out this 3rd pup (black and white).





Follow up: Jun 10, 2016 9 am
The 3rd and 4th pup had passed away. According to the breeder, the dam produced "toxic milk". He noticed too late the next day and farmed out the other 2 pups. They are still alive. "Even with my years of experience," the 80-year-old breeder lamented. "My judgment still cannot be perfect. When the dam has thick yellow milk, I should not let the newborn suckle. But it is difficult to know when to do it."

I introduced to him one lady who wanted to buy a Yorkshire with a full coat.