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Date:   26 October, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
 
CASE 1.  PREVENTING TARTAR BUILD UP IN THE DOG'S TEETH
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
26 October, 2010
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

A mother with four children - 12 years, 15 years, 19 years and 23 years brought 2 Malteses that are 2 years old for their annual vaccination. She made an appointment for dental scaling. Dental scaling was done under anaesthesia. Lots of brown tartar in the canine and back teeth, but the teeth are still solid and strong.
Questions asked by the mum:

1. Yearly dental scaling? Not necessary if there is no tartar. Just ask the vet to check the teeth.

2. Must brush teeth daily? Yes, if practical. If not, every 3 days.

3. Dog does not like brushing. What to do? Use thumb brush or rag to rub back teeth. Use treats to motivate.

4. How to prevent tartar build up on the teeth? Presently the dogs eat chicken meat mainly. "Add dry dog food for the dog to chew," I said. "There are also chew ropes, but one way is to feed dry dog food and brushing of the teeth."    

"My dogs will never eat dry food," the mother said.

"Even you will never eat biscuits if forced to," I said to the caring mother. "The trick is to add 5% to chicken meat, gradually increasing to 50% after one month. Delay dinner as the dog eats once a day."

As I had time, we talked about our experiences in bringing up children and she had four of them. "My 15-year-old is the naughtiest and always wants to go out."

"That's due to her hormones", I said. "She wants to meet boys. You need to spend some time with her, for example. exercising the two dogs together with her. Bonding with her, getting to know her better." I had thought that the 12-year-old daughter would be harder to manage as she should be having hormonal changes to become a woman. Yet it was the 15-year-old. I don't know much about daughters as I don't have any.  

The mum said she used to take half-hourly walks when first diagnosed with Diabetes Type II. Now, she gave up exercising. "You need company," I said. "It is just too boring to walk by yourself and spouses are usually not available or interested.

"You have two dogs. Just take one dog down at a time since two dogs are noisy. If you don't take care, you may get diabetes Type I and then you will need to inject yourself everyday ", I advised the mum. She has to take care of herself as she has 4 children and 2 dogs and that is a heavy responsibility.

CASE 2.  FOLLOW-UP 7 MONTHS AFTER
I EXTRACTED THE ABSCESSED CARNAISSAL TOOTH
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
26 October, 2010
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

What to do if you, as a vet do not feel comfortable in performing anaesthesia in old dogs which may only be cured if surgery is done?

I know of one vet who just simply refers all cases to another practice. "At least I don't lose clientele when I refer to this practice," this senior vet told me. The practice she referred her difficult cases to has several vets and branches. If my old colleague believes that referring her difficult cases to this group practice will not cause her loss of clientele, I find it hard to believe. I reserved my comments. 

A group practice with more vets has higher overheads and therefore needs the caseload to sustain the profitability of the big operation and expand.  Recently I asked my mentor about this vet's comments. My mentor who is in his late 60s said: "Once you refer a case, you'll lose your client." 

Referring to other practices means losing clientele. There is no way to stem such losses if the vet does not want to perform risky surgeries that will harm his or her professional reputation.

Deaths on the operating table are very emotional and unpleasant issues.  In one example of the old Chihuahua with an abscessed carnaissal tooth, the vet just advised conservative treatment for 12 months. This case is written at:
Carnaissal tooth abscess in an old Chihuahua. Moral Ethics v. Economic Realities. 

This vet would not perform surgery knowing that the dog might die. "The vet told me that the average Chihuahua lives up to 9 years," the young man told me. The old Chihuahua had already made it to 10 years and the vet was wary of killing the old girl by performing anaesthesia.

The extraction of the infected tooth would cure the dog and give her a higher quality of life. But the dog could be dead on the operating table when given general anaesthesia. And his reputation would be tarnished badly. There was a competitor round the corner and grieving owners and their families with a dead dog on the operating table seldom has kind words for the veterinary surgeon. Some bear grudges for a life-time and bad-mouth the vet for being inexperienced. So, I understand the reluctance of this vet to perform the surgery.   

Anaesthesia in old dogs is going into areas where angels fear to tread as it is high risk. Yet, some surgeries cure the dog promptly. There is always a big dilemma for vets encountering such situations. I was fortunate in this case as the old Chihuahua survived.  I will say that some old dogs do die on the operating table due to various reasons when I did such cases.  

It was a joy to see this Chihuahua some 7 months after I extracted her abscessed carnaissal tooth and many other teeth. I tried my hand at making a short video with the help of an intern at: Abscessed Carnaissal Tooth Diagnosis and Treatment Video Education For Vet Students. Three follow-up pictures of the pretty Chihuahua are taken for viewers:
 
  7 months ago
Dirty, wet itchy left facial area below the eye. The mum had to clean the non-healing wound for the previous 12 months. It was a daily chore for the old mother for 12 solid months.
7 months later
No pain and good looking and a happy mum. The grown up son had to seek a vet who would operate on the dog but he knew it was a high risk anaesthesia. It is not always a happy ending. Yearly dental check up by your vet will prevent so much dramas and worries for the family members who are care-givers to the dog.  
7 months ago, left facial wound, weepy, non-healing due to abscessed carnaissal tooth. Tooth extracted. Now ok. toa payoh vets, singapore  7 months ago, left facial wound, weepy, non-healing due to abscessed carnaissal tooth. Tooth extracted. Now ok. toa payoh vets, singapore  7 months ago, left facial wound, weepy, non-healing due to abscessed carnaissal tooth. Tooth extracted. Now ok. toa payoh vets, singapore
CASE 3.  FOLLOW-UP 8 MONTHS AFTER
I EXTRACTED THE ABSCESSED CARNAISSAL TOOTH
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
26 October, 2010
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129


Old Chihuahua, Severe anaemia, high platelet and white cell count. Toa Payoh Vets, singapore8 months later. On Oct 21, 2010, the old Chihuahua passed away peacefully at my surgery after 2 days of hospitalisation for not eating, ataxia and severe anaemia. She had an extremely low red blood cell count and a very high platelet count. An extremely high white cell count indicated bacterial infection of the blood.  Her liver enzymes and serum nitrogen were elevated. Creatinine was normal

Two blood tests were taken but the second one showed a very high white cell count. The cause of death was hard to say without more tests. The high platelet count was very rarely seen in practice. Could this be a blood cancer or open pyometra?

"Your dog has lived to a ripe old age," I said to the young man and his mother who were called to see the dog to say good-bye on the evening before she passed away.

"I will not be recommending blood transfusion," I said. "The dog is very old as most Chihuahuas don't live up to 11 years old. "The blood transfusion will just kill her."
"Put the dog to sleep now," the mum said during the evening visit. The Chihuahua was unable to stand and her body temperature was dropping below 36 degrees C.

"No, no, no" the young man said. "She may recover." The dog was very weak and pale. She was not vomiting nor did she eat or drink. She passed away around 10 am and I phoned the young man. He came with his mum. 

The young man and his white-haired mum were satisfied that the Chihuahua had a good 8 months of high quality life.

After the cremation arrangements and before saying good-bye, the mum hugged me to thank me outside the surgery entrance. I was surprised as Chinese baby-boomer generations seldom hug outsiders or even family members. That is part of my baby-boomer generation's culture. Chinese seldom hug each other as we are not brought up to hug each other.

Then she hugged her son who comforted her. We said good bye. I had a heavy heart that morning as there was nothing I could do to reverse the impending death. Blood transfusions would not work but would just add to my veterinary income. I feel that it is  not right to milk my clients by advising blood transfusion when there is no hope of a longer life. I am sure the son would approve of blood transfusions but it would not prolong the dog's life as the kidney and liver disorders were due to old age. The whole body system was shutting down due to old age.  

Would a spay when this Chihuahua was in her younger days help to make her live longer than 11 years of age? I believe it would.

"Did the dog lose a lot of blood?" I asked the young man earlier after getting the blood test result of severe anaemia. "No," he said. "Was she spayed?" I wanted to confirm as this dog was adopted. I noted a swollen vulval lips of snow white in colour due to severe anaemia. The normal colour should be pink.

Mum said: "The dog is not sterilised. She passed a lot of blood suddenly some months ago and then 1-2 months ago. She had had stopped bleeding previous two years. I did not think there was anything wrong with her bleeding."

"In hind-sight, this dog should have been spayed when she was younger," I told the young man. "It could have lost blood due to open pyometra recently."

The dog was adopted at the 7th year in a bad condition and was restored to good health, till the oronasal fistula affected her 8 months ago for the past 12 months before. Overall, this Chihuahua had been well cared for and Mum took her down three times a day to exercise. The dog was quiet and much loved by all neighbours. 

Would  she live longer if her infected carnaissal tooth had been extracted as soon as she had the facial wound instead of dragging on for at least 12 months and causing her poor health, stress and bacterial infection?  I believe it would. Much depends on the dog owner to seek out treatment early for the sick dog if the illness still persists.  

The young man who knew me through surfing the internet  texted: "Thanks so much for helping April. Most appreciated! :)".  Young people don't converse; they use their fingers to do the talking.

TIPS FOR A LONGER LIFE FOR YOUR DOG OR CAT. An annual health screening with blood and urine test and dental check up is best for older dogs if you want your companion to live longer as many diseases can be prevented. Sterilisation of your dog is advised.  
 

More info at: Dogs or Cats
To make an appointment:
e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326

toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
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