33. The Breeder Who Cried Wolf

April 29, 2016

I have my morning off today intending to send a friend off to Japan by driving her to Changi Airport at 8 am.

The breeder phoned at 6.30 am wanting a Caesarean section for his 6lst-day-pregnant Corgi. I cancelled my morning off.

The dam had started contractions at 4.30 am and no pups had been born.

So, I got ready with my assistant to meet him at Toa Payoh Vets. As I was ready to go out, he phoned to say that the Corgi had given birth to a puppy and so he cancelled the appointment. I looked forward to my half day off as I had been working long hours 7 days a week for the past months.

After the first puppy, a second puppy was born naturally at 9.30 am. The dam strained but no puppy was produced and the breeder phoned me at 12 noon to request a Caesarean Section as he knew that the dam have many puppies.

This was a breeder who cried wolf and so I was not going to rush to the Surgery and have him cancel the appointment again. He did not want other vets to operate on his dog.  He had lost 8 Corgi puppies during a C-section done by a younger vet recently and that $40,000 loss of puppies was attributed to an inexperienced vet.

So I rushed back to Toa Payoh Vets and got the Caesarean section done. The dam was passing lots of red blood and this was not a good sign. It indicated that the umbilical cord of a puppy stuck inside the vagina had ruptured its umbilical blood vessels. Lots of red blood dribbled out. The Corgi dam was in pain as she got agitated when I washed her back area to clear the blood.



ANAESTHESIA
Isoflurane gas by mask, intubate. My assistant Judy inflated cuff to ensure close fit.
"Maintenance anaesthesia should be less than 2%" I told to monitor closely the dog's vital signs. "In some cases, it could be less than 1.5%. In this careful monitoring, no dam ever died on the operating table. A dead dam is disastrous to the dog breeder as the puppies will have no milk to drink."

Vets must think from the breeder's point of view and a Caesarean section must be done speedily and correctly. I had performed around 5 Caesarean sections for this breeder without any death of the dam and puppies and he was reluctant to try another vet with lesser experience. I had operated over 100 Caaesarean sections for breeders at a time when the breeders lost their regular vet who was de-licensed for a year. So I had a track record and he preferred me to do it.

I am particular about the accuracy of the anaesthetic machine. It must be serviced and able to deliver the correct amount of gas as stated in the meter. If it says 1%, it must produce 1% and not more.
I have a dedicated experienced anaesthetic man who had just maintained the machine and I could use 1.5% to maintain the anaesthesia, using semi-open circuit in this case.  2.5% is advised in some veterinary anaesthesia books and I note that some vets use 3%. That may kill the dam or puppies or both.

A vet's reputation depends on whether he or she can deliver live puppies and dam at the end of the C-section and speed of surgery is paramount. If the vet is tardy, the dam may die from a lengthy surgery and the experienced breeder will blame him or her for being incompetent. This breeder had engaged more than 10 vets to do C-section in the past 40 years and so he could assess the skills of various vets and how he rated them. Still, I cannot be complacent and tardy.

IV DRIP
Hartmann's solution was given before op. Calcium is important for this dam.  I added 5% glucose for around 5 minutes and another bottle of Hartmann's plus Vit Bs for this dam.

BLOOD LOSS.
The gums of this dam were snow white at the end of Caesarean section, indicating a large loss of blood. This dam had an unusual large amount of bleeding as one dead pup with the tongue sticking out had already separated from the placenta and blood vessels as it was stuck inside the vaginal canal (video). I had the blood aspirated from the abdomen before closing and that added some minutes to the operation. I feared that this dam would die from haemorrhage.

SURGERY
The textbook advise a long incision and exteriorize the gravid uterus. This takes four times as long and the wound is lengthy. I made a short incision twice the width of the Corgi puppy's head. That would be around 10-15 cm of the skin incision. The uterine bifurcation is palpated and I made a similar length uterine incision and use my fingers to hook out the puppies. I exteriorize the uterus after all 5 puppies had been manipulated out to ensure no puppies have been hidden deep inside the rib cage area. I believe that a small skin incision will be better for the dam and has less likelihood of stitch breakdown and this is true for my over 100 cases of C-sections done. The vet textbook still advises the very long incision of the abdomen so that the whole uterus can be taken out and the puppies can be milked out easily. Operating time to stitch up the wound takes much more time.

SAC - Speed, Accuracy and Completeness in surgery.
Speed - A surgeon has less risk of anaesthetic death if he can be speedy in surgery.
Accuracy - Know the anatomy and where to cut
Completeness - Ensure that no puppies are left behind


PAIN KILLER
In this case, I injected methone at 0.25 mg/kg SC (10mg/ml) and gave 0.3 ml SC. I phoned the breeder at 9 pm, some 8 hours after the surgery. He said that the dam had an excellent appetite on going home from the C-section. I attributed this to the pain-killing effect of methone. Usually I use tolfedine which may not be so effective as a painkiller but there is no scientific study done by me.

CONCLUSION
The breeder had given 0.5 ml of oxytocin and another 0.5 ml of oxytocin to get uterine contractions. The contractions started at 4.30 am. lst pup was born at 6.45 am. 2nd pup was born at 9.30 am and no more. Caesarean section started at 12.30 pm and one pup with the tongue sticking out of the mouth would have died inside. Another pup was distressed. Altogether 5 pups. 4 were alive.

If the breeder did not cry wolf, the dead pup would be alive as C-section would be performed at 7 am as I had prepared for the operation.

Despite some 40 years of experience as a breeder, there is much to learn. My advice to the breeder is to get an elective C-section done if the dam has more than 4 puppies and if the time interval between pups is more than 2 hours. This is from experience and from some breeding books I read.


HOW LONG IT TAKES TO OPERATE IN THIS CASE?
B:  12.20pm Isoflurane gas by mask first, then intubate
C:  1.33 pm  Gas stopped.
D:  12.40pm  First skin incision
E: 1.33pm     Completed skin stitching

E-B = 73 minutes

Maintenance of gas  1-2% generally.


TIME TO STITCH THE UTERUS IN 2 CASES OF CASESAREAN SECTIONS

12.52 pm. Started stitching uterus. 2 rows.  5 puppies handed to breeder with umbilical cords clamped with forceps.
1.04 pm  Uterus stitching completed.   My assistant commented that I took a long time to stitch the uterus as compared to taking out the 5 puppies from the uterus. The time taken to stitch is 12 minutes as the uterine incision was 4 inches long and I stitched two rows.



Compare to the Yorkshire Terrier stitching of uterus (earlier case) - Caesarean section around Apr 22, 2016.

9.28 pm Started stitching uterus. 2 rows.  5 puppies handed to breeder with umbilical cords clamped with forceps.
9.43 pm  Uterus stitching completed.
Time taken is 15 minutes

32. Inspiring images: Strong work ethic

31. A Cavalier King Charles X has an itchy right backside

Tuesday April 26, 2016  Queen's Veterinary Surgery

Dr Daniel has his day off on Tuesday and so the mother and young adult daughter brought their dog to consult me at 7.30 pm at Queen's Vets.

"His right backside is itchy," the daughter said that this dog did not bite his tail, scooter on the floor nor chase its tail.  I placed the dog on the table and expressed the anal sacs which were not obviously swollen under the skin. Copious amount of yellowish oily fluid shot out onto my tissue paper. The daughter was careful not to stand behind the dog as she must have read about its foul-smelling oil which would squirt out like a bullet, exploding onto her face or dress. 

So, was this a case of anal sacculitis? Yes. I explained how the anal sacs can be expressed weekly by the person bathing the dog. "Who bathes the dog?" I asked. "It's the father," the mum said. "He should be here, as he is the correct person to teach how to express the anal sacs" I replied. "He is at work."

"Has my dog any more ringworm and does it infect people?" the mother asked. The dog had been given 20 days of anti-fungal medication and had been clipped bald.

"There are no more bald patches nor scales," I noted that the dog had recovered fully. New short hair covers the whole body.

"Are you sure?" the mother asked.
I did another close check up. On the left side of the base of the tail, hidden amongst the growing 5mm-long brown hairs, there was a bright red skin ulcer of around 5mm x 3mm. Hidden at the corner of the tail base and backside.

This could be a new area of ringworm infestation and to be careful, I prescribed another 15 days of anti-fungal . Generalised ringworm is very difficult to treat but this mum and daughter had done a wonderful job such that I thought the dog had recovered 100%.  The tail biting complaint was on the right backside. It was a clue but most likely, the left backside beside the tail base was the real itchy spot. 
 

30. The top pet hotel in Singapore

April 27, 2016

At 2 pm, I drove to 27B Loewen Road, off Dempsey Road to look for a veterinary clinic called Sinpets.

It had closed around 6 months ago, according to the staff of the one-year-old The Wagington Luxury Pet Hotels & Resorts which was its neighbour.
 

I was invited in by the proprietor and this pet hotel is top in its standard of service.

Owners can view their pets on CCTV.
There is a swimming pool for dogs and owners. There is a shower for owners.


Groomers are available and de-ticking service is provided.  The building is a large 2-storey detached black and white bungalow converted into a pet hotel and resort.  

This is Singapore's only luxurious boarding hotel for dogs and cats, fully air-conditioned and free of smells at the time of my visit.  Great location and great place for your pets. 

Details at: www.thewagington.com.sg

29. A 5-year-old terrapin bites as he has mouth ulcers

Sat April 23, 2016. Day 3 of hospitalisation and treatment

The terrapin had swollen eyes and will not eat. Terrapins don't eat when they can't see. So, the owner was concerned and brought him to Toa Payoh Vets. He was warded for 3 days. On Day 1, he would open his mouth whenever we tried to get her to open her mouth. Most terrapins will keep their mouths shut and withdraw their heads inside the shell.

So, was this an aggressive terrapin?
As he opened his mouth on slight provocation, I could examine his mouth. The tongue was swollen and ulcerated. As he opened his mouth, we squirted baytril antibiotic into his mouth and that was how he got his medication for the next 2 days.

Eyes no longer swollen and corneas have cleared. Infection is the cause. Poor tank or water hygiene.  The tongue was much swollen and ulcerated on Day 1 and the terrapin was aggressive, opening his mouth to bite every time I approach his lips with the syringe. I observed him regurgitating cloudy water which drooled to his chin area. That was on Day 1. 

It is difficult to examine the biting terrapin's tongue on Day 3 of hospitalisation. He is wiser now and does not open his mouth readily as inflammation had subsided after oral baytril antibiotics for the past 2 days.

He is very active goes home today. You can see that his tongue has firmed and become smaller (no more inflamed) at the first few seconds of the video. I note that he does not regurgitate or "drool" as on Day 1. This drooling was likely a case of stomatitis (inflammation of the mouth), just as dogs with severe mouth ulcers drool too.

A very well cared for good bodily condition terrapin
A busy Saturday for Dr Daniel and vet assistant Judy and receptionist Judy. No time to sit and eat
lunch leisuredly.

28. The 7-year-old not spayed female Silkie Terrier had seen 3 vets but still passed strong smelly urine

April 28, 2016


Yesterday, the dog owner came to buy a bag of K/D and I review her dog's medical record. 

This is my 2nd case of recurring STRONG SMELLY URINE in a female dog despite consulting "many vets" and getting all tests done. There was no reprieve from the urinary tract infection and 3-4 vets were consulted in the past 1 year. 

So, on August 15, 2015, she consulted me. Smelly urine with blood and pus is passed out every now and then but not every month. The dog had heat usually in June but in 2015, there was no heat. I did not do X-rays but just a blood test and urine test. The blood test showed no abnormality of the kidney or other organs. The urinalysis showed positive nitrite, protein 4+, blood trace, crystals of triple phosphate+ and amorphous phosphate 3+. Urine pH 9.0 and SG 1.035. I palpated the bladder.It had thickened wall indicating chronic cystitis. the right kidney was painful.
The vulval area was hyperpigmented black indicating long-term licking. There was vaginal discharge and the dog had milk in the mammary glands indicating false pregnancy and possibly open pyometra..

I advised the K/D diet to be followed by the C/D diet and spaying of the dog. The owner did not bring in the dog for review nor get any urine tested as the dog was peeing normal urine from August 2015 to presently in April 28, 2015.. She just purchased the K/D diet.


Today, April 28, 2016, the owner bought the K/D dry food and I asked if the dog still had strong smelly urine.

"None at all since your treatment in August last year," she said.


"How do you know she has stopped all heat bleeding?" I asked.
"My dog lies on the sofa and I will see blood stains, but in 2015, there were no stains." "Does she lick her private parts daily?"


I got a blood test and urine est done. 

"The vets consulted would do X-rays to check for urinary stones and invariably would find no stones," she said to me today. "They would do urine and blood tests and prescribe antibiotics. One vet even gave me a repeat course. But my dog would pee smelly urine again and again. That is why I come to see you."

27. A Yorkshire has a timely Caesarean section

Friday Apr 22, 2016

The quiet gentle Yorkshire Terrier is 59th day pregnant but she had stopped eating for the past 2 days. She became lethargic. What to do? The breeder brought her to Toa Payoh Vets for an IV drip at 3 pm. A bottle of Hartmann's solution "Glucose is important," I said to my assistant. "Give her 5 minutes of the 5% glucose IV."

The breeder intended to bring the dog back home to continue the IV in his farm. The IV stopped flowing as there was blood clot and he returned. Dr Daniel cleared the clots and the IV infusion flowed drop by drop.

"Best to leave the dam here till the IV drip is completed," I advised the breeder. By 6 pm, the bottle was emptied. The breeder brought the dog home.

At 9 pm, I was looking forward to my dinner. He phoned: "The green discharge has come out from the dam's backside. There is a water bag."

So, no dinner for me. I rushed down to the surgery.

Gas anaesthesia only. "Maintenance dose to effect," I said to my assistant. "Not just fixed at 2.5 to 3%.  A good assistant is worth her weight in gold.  Just observe the tongue colour, the eyelid reflexes and the breathing bag. Minimal anaesthesia. When the dog's legs or body move, increase the dose."

In this way, the Yorkshire was operated at around 1.5% maintenance anaesthesia. 5 black pups. All crying loudly, except one. I had injected oxytocin 1 ml and Baytril SC

Saturday Apr 23, 2016
I visited the farm at 9 am. A bright sunny morning. 5 pups were suckling. All had shiny coat and were active. The dam had eaten the chicken meat and so had produced milk.  The dam's bright eyes opened up directed at me, in case she had to protect her newborn. I videoed from afar. A happy breeder. An excellent output of 5 puppies. An excellent outcome of surviving dam and 5 pups. That is what the breeder wants. So, it is up to the veterinarian's skills and expertise in anaesthesia to produce such an outcome.

5 pups. Caesarean section from first time in giving isoflurane gas by mask, intubation and surgery to completion of skin stitching took 52 minutes. The pups in their water bag were clamped and given to the breeder and his Myanmar assistant to revive, tie the umbilical cord and clean up. 1 bigger pup was much distressed, according to the breeder today and he had to blow air and resuscitate to bring it to life.  (video).

The shorter the surgery, the better chances of survival of the dam.  Prepare the equipment and know what to do. Any death of the dam frightens away the breeder as he deems it is the vet's fault. Pre-op vet examination is important.  

26. A groomer refers an 11-year-old Schnauzer with 5 tumours

Thursday  Apr 21, 2016

Referrals are best. I was surprised that the groomer in East Singapore refers this Schnauzer with a bleeding paw to me. The neighbouring vet could be unaffordable for him. 

"Quick a big young lady in her 30s," the owner, a retired chef who cooked pig trotters with chestnut for an ex-Prime Minister in a private club. It must be delicious as the PM would order in advance.

This dog has a thick swollen paw pad in the left hind limb, 5th digit. Size is about 3 cm x 3 cm. "Probably an infected pad in which something had got inside," I said. "So, the dog kept licking it till it bleeds."

Basically, this is a lick granuloma. The best option is to excise the whole lump with the 5th digit. But the dog is overweight and anaethesia is such a high risk for an old dog much loved. The lump is also very dirty.

The owner accepted my advice to reduce the weight feeding R/D at 125g of dry food per day for 2 months to reach a bodyweight of 9 kg. However, one month with daily exercise will do as the weight should be around 10 kg.. The owner will clean the wound daily and give antibiotics and anti-inflammatory for 14 days. Keeping the lump clean will be best for a fast recovery of the amputated digit. The skin warts and the lower eyelid tumour (video) can be excised within a few seconds using electro-surgery.  Estimated cost of treatment of amputation of one digit + lump + 2 skin warts + 1 lower eyelid tumour will be around $500.

I will see the dog on May 21, 2016.

25. A 2-month-old Maltese has diarrhoea

April 20, 2016

4 days ago, the breeder brought this smaller than normal sized Maltese, amongst others, to me for a 2nd vaccination. This puppy cried loudly after my subcutaneous vaccination above the neck and had objected to the dam cleaning her up. Today, at 9.30 am, he appeared suddenly with this puppy in a crate.

"It is a vaccine reaction," the 80-year-old breeder had seen various vets throughout the years and noted that particularly small-sized Malteses and Chihuahuas do not take vaccination well. Some die a few days after vaccination. I did have such a case in another breeder some years ago when I was vaccinating puppies of another dog breeder in Singapore.

"The gums are normal," I examined the puppy. "However he cries when I put the stethoscope on both sides of his chest. He could have been laid upon by the dam. His diarrhea could be due to the stress of traumatic injury or picking up some infection."

"It is not possible for his dam to lay down on him," the breeder denied. "He might have been disturbed by my young Myanmar assistant who likes to tease the puppies by pinching them."

This "mini-Maltese" is a runt. A confirmed buyer was to take him home today. He had been weaned by eating the dam's food but was still suckling.
 

I prescribed an electrolyte package and asked him to give a ml or two every one hour in addition to the Nutripet paste prescribed by Dr Daniel for his other dogs.

The breeder had given Scourban antibiotic yesterday and the puppy had passed more solid stools. However, he had lost appetite for the past 2 days and the breeder predicted to me now, "No hope, no
hope for this one,"

At 9 pm, I phoned him from Queen's Veterinary Surgery as I was closing for the long day.  "He is well now. I gave him roast meat this evening and he greedily ate them."

"We learn every day," the breeder concluded.
"Yes," I said. "Every day, new things happen."  His prediction of another death from a vet's vaccination of a runt was not correct as each case varies and he had been instructed to take care of this sick puppy every hour and keep him in a warm place.

24. Urethral stones- cannot pee

Mon April 18, 2016

A woman in her late 40s surfed the net and brought the dog to me today. The previous vet had x rayed and showed small urinary stones stones. The vet prescribed medication. On the next visit, the same vet prescribed medication.  This happened over the past 3 months. But today, the dog vomited 6 x in 2 days and now could not pee.The bladder was mango-sized.

X rays after taking out the urine and pumping in 20 ml air to get good contrast.

I need to process the x-rays by labelling them for the owner to read. I WhatsApp to owner to show  the stones. They could not be peed out. Urethrotomy was done.

23. A hypothesis of a canine tooth abscess in a 16-year-old Sheltie with right nasal discharge for 6 months

Sat Apr 16, 2016

An unusual rare case correctly diagnosed.
Runny nose, pus coming out from left nostril for past 6 months.
Old Sheltie. What's the big deal? Old age does not mean there must be incurable nasal infections.

A bright clear sunny morning. I did not expect the Sheltie owner to come for dental. In fact, she came for vaccination of the old dog after consulting Dr Daniel as I was away at Queen's Veterinary Surgery and had just arrived back at Toa Payoh Vets. 

10 days ago, the couple consulted me about the left nostril discharging pus. Dr Daniel ahd prescribed antibiotics one month ago but the discharge continues. The dog objected to me opening his mouth on the left side and so I did not force the parting of the left upper lip to palpate the gums.

I had this hypothesis. The dog is very old and the root of the left upper canine had rotted and decayed owing to lack of tooth brushing. The decayed root shrinks and bacteria multiply inside the surrounding cavity. The bacteria made a bridgehead invading upwards into the nasal passage and form an abscess. This is called medically a sinus as contrasted to an oro-nasal fistula in which the skin has a non-healing wound as in a carnassial tooth abscess. This will be a canine tooth abscess, as the canine tooth is involved. Extraction of this tooth will resolve the problem as is done in the equivalent extraction of the carnassial tooth.

The couple appeared to accept my explanation and dental work is scheduled 10 days after antibiotics, namely, today. But I was out and Dr Daniel was consulted. Vets give the usual anaesthetic death warning as part of the informed consent for surgery. He noted that the risk is very high as the dog also has heart disease which is not controlled by medication.

The couple decided not to risk it and so just did the vaccination when I arrived at Toa Payoh Vets..

"If you don't remove the decayed loose tooth, the dog will get persistent left nasal pus discharge and later on, death from pneumonia." I said. "The bacteria will spread up into the lungs in time to come and the dog, being old, has no resistance to its invasion.

"The risk of dying is very low for old dog dental work in my cases," I said. "I cannot guarantee 100% success but your dog has good health from blood test and the risk is the bad heart failing under anaesthesia. However, I use isoflurane gas which is very safe. The whole anaethesia should be less than 10 minutes and so the chances of dying are very low, in my experience."

I have been in practice since 1974 and this is a rare case of canine tooth abscess hypothesis as I had not encountered such a case. Carnassial tooth abscssses are too common and all vets will have encountered them.

The wife consented and all went well. My hypothesis is confirmed and this dog has a case of canine tooth abscess. Very rare and probably not seen by most vets. Nasal discharge from one nostril on the same side is the presenting sign.

 

April 18, 2016 - 2 days after tooth extraction. The dog was warded as he had vomited twice in the last 2 days. It could be due to medication or endotracheal tube irriation. After an IV drip and painkillers, the dog was OK and went home. 

The owner was very much happier now that the dog's left nostril had no daily discharge as she had to clean up the soiled apartment daily for the last 6 months. Her joy was hard to put in writing but could be heard in the next video. 

22. How long does it take to neuter a 6-month-old Cavapoo? 14 minutes

April 15, 2016
Toa Payoh Vets

A breeder brought in a 6-month-old black Cavapoo for neuter (video). He believes that the younger a dog is neutered, the less likely he is to urine mark.This is usually correct.

TIMING
2.36 pm   Inject Domitor + Ketamine 0.13 + 0.15 ml in one syringe IV with added Hartmann's to make up 0.5 ml. Neuter surgery. 2 testicles
2.50 pm  Dog 's skin is stitched. 

CONCLUSION
There is a short duration of IV anaesthesia after injection. This case study shows it is at least 14 minutes.

The vet must clip the operation area before sedation to save time.
2 testicles were removed. Open method. One ligature of the spermatic cord. 5 throws on either side. 2 skin sutures, interrupted. Skin incision 0.5 cm. (video).   Dog woke up without the need for Antisedan antidote to reverse Domitor.  

21. The black and white cat vomits hairball again. FUS?

Tuesday April 12, 2016


"He is a devil at home," the daughter brought this 2.5-year-old cat to consult me today as regards his recurrence of vomiting hair ball yesterday.  The cat permitted me to examine him without clawing me and I said he was a gentle cat. He would growl at the owners whenever they handled and petted him.

"Has he got a nemesis?" I asked her. "Another male neutered cat that stress him. He is living in a multi-cat household and there may be conflicts of personality."
"Yes, yes, there is another male cat of similar size. He tries to avoid him."
"But they all share the same gully trap to pee," I said. "So he may be upset by sharing the same elimination area."

I examined his genitals. No swollen prepuce this time compared to 6 weeks ago when he came for unusual frequent hair vomiting. However, his penile organ was deep purple and leaked urine. I palpated his bladder and he reacted. So, the could be a case of FLUTD.

I advised a separate peeing area e.g. newspaper with his urine in a corner of the bathroom.

20. A 12-year-old Shih Tzu coughs and pants a lot - congestive heart failure

April 11, 2016

The 12-year-old Shih Tzu was coughing for some weeks but now the coughing and panting becomes too frequent.
"It could be the smoke from the praying to the dead," the husband said. "But my dog did not go to the graveyard." This is the period where graves are cleaned and food offerings are given at the graveyard.
 
The dog was heaving and the abdomen appeared swollen. The right heart had a loud systolic murmur.  X rays confirm congestive heart failure. Heart enlarged considerably and the lungs are filled with fluid (pulmonary edema).

Heart medication is given for 2 weeks and will be reviewed. Each vet has his or her own idea of treatment. I usually prescribe 3 types of heart disease drugs but my other vet prescribe Vetmedin only. I gave the dog an IV glucose, antibiotic and lasix to ease his pain and clear the lungs.  

The tongue was so cyanotic and the dog was panting so badly that I gave oxygen therapy. However, the owners had to go home as the therapy took more than 30 minutes.

I advised the Prescription Diet H/D but the owner does not want it.

Right sided heart enlarged and lots of fluid inside the lungs - difficulty in breathing for the dog. 

Nowadays, the Singaporean pet owner is better educated. He wants to know the prognosis. X-rays will show the severity of the heart disease, the shape, size and surrounding lung fluid. The vet must produce the X-ray or ultrasound evidence rather than prescribing medication trying to lower medical costs. 

19. Images of Singapore and others

Difficult to get the correct angle. It is good to have a person to show the dimensions.

18. VIDEO SCRIPT. A young poodle has severe anaema and thrombocytopenia due to Babesia canis tick fever

TP ..948

April 7, 2016
I got a 1-year-old poodle, lethargic and pale in the gums and tongue.

BLOOD TEST   Apr 7, 2016
                            Toa Payoh Vets  

Haemoglobin     5.2 (12-18)
Red cell count    1.9  (5.5 -8.5)
Platelets             <10   (200-500)

Total White Cell count  21.4 (6-17)
Neutrophils  81%  (60-70%)
Neutrophils absolute 17.3    (3-11.2)

Haematocrit  0.16  (0.37-0.55)
MCV  87  (60-77)
MCH   28 (20-25)
MCHC 32  (32-36)
RDW     24.1%
A regenerative anaemia based on increase in MCV and MCH
The owner did not accept my advice to get a blood transfusion.
No liver and kidney disorder

Blood smear     Babesia +ve

 
Imizol (imidocarb dipropionate 120mg/ml, SC  0.2 ml given at 3 pm
Dog ate 2 days later and has recovered.       

------------------------------------------------------------------------------------
RESULTS FROM ANOTHER VET (VET 1)  consulted earlier
The grown up children consulted Vet 1 although the father said he wanted them to bring the dog to me. The following are the tests done by Vet 1, an experienced vet.   

BLOOD TEST   Mar 26, 2016                          


Haemoglobin     low
Red cell count    low
Platelets             low


Peripheral blood smear, SNAP 4DX Plus Heartworm done.
Given Iron tablet, prednisolone, IV infusion, Ranitidine 50mg/2ml, Sucralfate 500mg tablets


BLOOD TEST   Mar 30, 2016.
                          

Haemoglobin     low
Red cell count    low
Platelets             low

Given doxycycline 100 mg tablets

The dog was still lethargic and not eating. The father brought him to Toa Payoh Vets on April 7, 2016 and the blood smear showed Babesia canis abundantly inside many red blood cells.


FOLLOW UP
Apr 21, 2016 (2 weeks after the first imizol linjection)
The parents who love this poodle very much brought him  to Toa Payoh Vets for blood test and blood smear 2 weeks after the first injection as advised. The dog had been prescribed Vit K1 10 mg per day but the owner gave 5 mg/day. Nutripet paste with iron and vitamins much loved by this dog but not the Vit K1.

Blood smear by Dr Daniel showed fewer red blood cells infected by Babesia canis compared to 2
weeks ago when almost 90% of the red cells are infected (see above image).

                              Apr 21                       Apr 7               Range

Haemoglobin         5.2                            8.9                    12-18
Red cell count        3.7                            1.9                    5.5 - 8.5
Platelet             less than 10                                             less than 10.              
                         large platelets present                             no platlet clumps seen
PCV                      0.27                           0.16


MCV                    74                                       87*                     (60-77)

MCH                    24                                     28*                       (20-77)

Blood test  show an increase in red cell count and haemoglobin but still below the normal limit. There was a regenerative anaemia (*) in Apr 7.



The platelet is still less than 10 (as 2 weeks ago) but the dog's gums are pink. (see video).  


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CONCLUSION

The father said that his poodle does not have any ticks.

Vet 1's peripheral blood smear did not show Babesia as not many red blood cells have been infected at that time on March 26, 2016. When the dog was seen by me on April 7, 2016, the blood smear showed the Babesia canis in large numbers.

So, I was at the right place and at the right time to produce the positive smear which had around 90% red blood cells infected by Babesia canis.

In conclusion, it may be better to treat a dog with severe anaemia and thrombocytopenia as tick fever although the blood smear is negative. Babesia may not be present in that smear and so the dog's medical condition deteriorates.  It has been reported that most Babesia infected dogs recovers rapidly with treatment and that they become carriers. A second injection should be given 2 weeks later and a blood smear should be done.  

This dog appeared to be recovering slowly but is still eating and active.

17. Amitraz tick wash poisoning twisted neck

"It is scary" the owner saw his old Westie suffering from a necked twisted to the right one hour after he bathed the old dog with Amitraz wash






When applying pesticides, always follow the label's instructions when you make the solution. High doses kill
2. Spraying when the dog is heavily infested can kill the dog as he is already ill ith tick fever.  Bld test x2  showed Westie was much badly infested n sick

GR

TWC  23  6-17
N        93%   Abs  21   3 -11.5

Westie

16. Images for future articles

Monday. April 11, 2016

An artist sketches things that inspires him or her to collect ideas for future paintings. I upload pictures.

Before Imizol injection

After Imizol injection. Tongue and gums pinker

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15. An 8-year-old carnivorous terrapin has 2 swollen eyes

April 5, 2016

"This terrapin eats only meat, mainly fish and prawns as she rejects the pellets," the woman said. "For the past 4 weeks, she has no appetite as my domestic worker sees the meat still present inside the tank.

In the past, the terrapin will eat all and be taken out of the tank after 2 hours to roam on the floor. But in the past 4 weeks, the domestic worker had retained the terrapin for 4 hours to ensure she will eat. But she had no appetite.

"When do the eyes become shut and the eyelids swollen?" I asked.
"I don't know," the mistress said. Neither did the domestic worker who mentioned that it could be the past 2 weeks. The water was very dirty with stools and meat during the 4 hours and this poor quality of water irritated the terrapin's eyes. So painful were the eyes that the terrapin shuts the eyelids and will not eat.
"How long will she recover?" the mistress asked.
"It is hard to tell. It depends on how badly infected the eyelids are," I could see the terrapin using his right fore hand to rub his right eye.

I hospitalised the terrapin for 2 days giving eye drops and medication and warm morning sunshine for 30 minutes. Her left eyelid started to open first showing a cloudy upper cornea. Then the right swollen eyelids opened. The next day, the eyelids were much less swollen.

So, on Day 3, the terrapin went home. I advised changing of water twice a day. Apply eye drops and give medication inside the prawns and fishes. Also to vary the diet and introduce pellets.

14. A 16-year-old Sheltie has left nasal discharge

April 4, 2016

"Nowadays, she will only eat when I hand-feed her," the mother said. "She used to be greedy for food."

The mother had adopted a 16-year-old Sheltie as a 12-year-old as her friend could not cope with 2 dogs.

"It is very kind of you to adopt such an old dog," I said. "Most people will not do it as there will be short life span and medical problems of aging."

The dog will not permit me to open her mouth. "There may be painful gums," I said. "The left nostril is dribbling with pus too. It is an upper respiratory tract infection since 2 months ago when you came in for examination and she needs a more effective antibiotics. "

Losing interest in food in an old dog could be due to many causes. One of them is tooth ache. Another could be cancer of the internal organs. A blood test is done.  

13. A 14-year-old growling Jack Russell "vomits"

Monday April 4, 2016

This male 14-year-old Jack Russell growls at me but his back limbs trembles most of the time. Is he afraid of me or has he some nervous disease of old age?

I saw him as a young puppy and now he is a senior citizen. The owner used to feed him chicken bones and he used to vomit and get diarrhoea. That was in the past.

The owner is busy as a travel agent driver and so is vague on the dog's symptoms. "I noted that he was not active and had vomited once or more...I don't know."

The dog has fever and his eyes would close now and then. He limped on hi right hind. The owner will arm lock his head while I examine the dog. "There is the heart murmur on the left side," I said. "He might be "coughing" rather than vomiting".

Blood test showed bacteraemia and low red cell count and haemoglobin. 

12. Dental disease. A 13-year-old Jack Russell has a 2nd carnassial tooth abscess 2 years later

April 4, 2016

The young lady spotted a big swelling below the left eye and consulted me.
"It is a carnassial tooth abscess - an infection of the 3 roots of the 4th premolar tooth into the sinus. The sinus is near the roots and so get infected and becomes swollen. The treatment is to extract the tooth and drain the pus."

"Can my dog still eat dry kibbles if you pull it out?" she asked.
"He has other teeth. If I don't extract the tooth, he will get recurring swelling of the face below the eye."

Under anaesthesia, the old dog needed minimal gas at 0.5% maintenance unlike young dogs needing 2.5% or they will wake up.

Pus oozed out from the front of the first root out of 3.  The roots were still firm as the young lady was observant and detected the swelling early or she must have had done research. So, should I leave the decaying tooth alone as desired by the lady?  There will continue to be facial swelling which will rupture under the skin causing an oro-nasal fistula. So, I decided to get the tooth extracted though it is harder to extract the other 2 roots.


I gave the dog an IV drip with painkiller and antibiotics 4 hours before surgery. Domitor + Ketamine IV at 20% normal dosage. Gas isoflurane + O2. Dental work. Then an Antisedan antidote to reverse the sedation of Domitor. He woke up within 2 minutes and went home with one tooth less.

VIDEO

The surprising abnormality from the blood test:  Liver and kidneys although creatinine was low at 61 (89-177). However red cell count was 4.8  (5.5 - 8.5). The dog is OK now.



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FLASHBACK

June 1, 2014.  Right facial swelling below right eye with open wound oozing pus. Carnassial tooth extracted. No more problem till now 2016 when the left facial swelling occurred. So the young lady owner detected similar surgical condition and brought the dog for early treatment. 

11. Two dwarf hamsters had ingrown front teeth

Sunday Apr 3, 2016

It may be a coincidence but on Saturday and Sunday, I treated two hamsters with ingrown front teeth (video)  

CASE 1
Sunday. The lady decided to bring in 2 hamsters with swellings for consultation. One is 23 g, lethargic and very thin. It was dehydrated and has a big abscess below the chin.  This was the one with ingrown lower front teeth. The other is 40 g and has a nose bridge abscess.

CASE 2
Saturday.  A 4-month-old thin Syrian hamster has two upper front teeth ingrown into the hard palate.

10. Skin disease. Spending over $1,000 on skin disease treatment of a Jack Russell - ventral dermatitis

Sunday Apr 4, 2016

"Is there a cure for my dog as I had spent over $1,000 in veterinary fees to treat my itchy Jack Russell," the lady had consulted me in Oct 2015 for the itch skin disease. She did not return for a review one month later as advised as the dog had fully grown a coat.

She had consulted 3 vets for the skin disease before Oct 2015 without successful permanent cures and that added to the veterinary expenses.

Now the Jack Russell has a big bare red belly with white rings of various sizes but the 2-cm across rings were prominent. She had treated the dog with over-the-counter shampoos and other medications but the dog scratched more.

I showed the lady they glowed under the ultraviolet light and examined the hairs under the microscope. Ringworm is the diagnosis as in Oct 2015. Other parts of the skin had rashes hidden under the thick wiry coat.

The dog was clipped bald and looked like a Dalmatian with red spots (video). Generalised ringworm again.

Why?

"There are ringworm-contaminated places in your apartment. The dog lies down on this area and gets re-infected after recovery in Nov/Dec 2015," I said.
"He lies down anywhere," the mum said.

"Which is his favourite spot?"

After much thought, the mother concluded it was the floor under the piano. Thorough decontamination of the floor is needed. The dog ought to be reviewed in one month's time.  This is a recurring case of ventral dermatitis due to ringworm which had spread throughout the body. I suspected that the dog did not fully recovered as the owner did not return for the review.

Skin diseases can be expensive to treat. The owner may not comply with treatment instructions and the dog may reject the tablets. A monthly review is necessary but many owners do not bother.

9. Skin disease in 2 male, not neuterd Papillons

Sat April 2, 2016


Most Singaporean pet owners will just consult the vet nearby and so I was surprised to see the 2 male Papillons from East Singapore.

One had very intense skin itchiness from head to paws. He keeps scratching all day and night. So the couple probably surfed the net and brought them to see me. The other had a few ashes on the body and less scratching.

"It looks like a case of bite wounds due to bullying or play biting," I advised clipping bald of the serious skin diseased dog or both dogs. "Male dogs want to dominate each other as they are not neutered.

"The bite wounds get infected over time and become very itchy. So the dog keeps scratching. These are likely bacterial rashes as I don't find any fungal infections."

The husband was not convinced the skin disease was due to biting. After clipping both dogs bald, the wife saw 6 small wounds in an arc in the lower neck skin of the less infected dominant dog. "These are bite wounds," she said and I agreed.

"Likely to be the 6 incisor front teeth of the bullied male," I did not snap an image as evidence. "He fought back and managed to nip the neck of the bully."

What's the solution.
Neutering. However, the husband did not want neutering as this will take out the life and energy of the male dogs.
"Give them more outdoor space to run" I presumed the couple lived in a house. But a small apartment is where the two males live and so there will be bullying.

8. Ruptured air sac in a parrot - head and neck swelling again and again

Saturday April 3, 2016

An old client brought in an $8,000 Maine Coon cat that had loose stools for the past 4 days after attending a cat show 7 days ago. He wants to specialize in Maine Coons and to be known, he does go to cat shows.

"Once I had a prairie dog for sale," he showed me an image from the internet and said that it was not a real dog as it was more like a gigantic guinea pig and was herbivorous.

"AVA will catch you when you advertise," I told him.
"Yes, AVA officers scan the newspapers at night and pretended to be a buyer," he told me he was fined $1,000 as the officers went to his home and took the animal away.
"Where did it go?" I asked.
"It is at the River Safari in the Zoo," his wife told me. "It is shown one hour at night."
"If only we had microchipped the prairie dog," the wife lamented.

The couple has a genuine love for cats and exotic animals. The man showed me an image of the fanned pigeon and various lovely pictures of parrots.

"Would you as a vet have microchipped my prairie dog?" he asked me.
"If the AVA officers asked me who microchipped it, I would have to point them to you!"u

This man also had a parrot as a pet. It had a large skin swelling above the head and neck.

"Dr Kong put a needle in and got the air out," he drew an illustration for me. "But the swelling reappears again and again. The vet said it could be an infection from the mouth causing air to bubble and accumulate under the skin. He prescribed antibiotics but the swelling recurs again and again!

"Now, I just use alcohol to wipe the area of the skin for me to pierce a needle to deflate the air. Not just one needle. It will not work. I insert another needle at the other side of the swelling. And whoosh, the swelling goes down. The only problem is that I need to do it so many times. I note that the swelling is less substantial now.  Is there a solution to prevent recurrence?"

The cause is a large rupture of the anterior air sac.  The best practice will be for the vet to insert a drainage tube to let the air out daily and hence allowing the tear in the air sac to heal. The parrot must be rested. Alternatively 2-3x/day drainage for a few days by syringe.

Recurrence makes a client lose confidence in the vet. The same applies to ear abscess treatment in terrapins.

7. A beautiful sunset outside Queen's Veterinary Surgery.

How this picture is taken?

i was walking towards Farrer Road after leaving Queen's Veterinary Surgery. I usually carry my DSLR camera at autofocus.

The sun was setting but dark clouds drifted to shield it. I snapped this image hoping to get a full view of the sun. This was a split second but dark clouds drifted downwards obscuring the sun.
.

Compostion. A good composition would be the background trees of a house forming a nice arc pointing upwards to the sun. .

Queen's Veterinary Surgery has a very pleasant residential surrounding unlike the rough industrial area around Toa Payoh Vets. Young parents with pre-schoolers and secondary school students pass by, giving a young vibrance of spring to this area. There is human traffic

If I was a young vet, I will prefer to build up my practice at Queen's Veterinary Surgery and not in the rough industrial area where Toa Payoh Vets is located.