129. New pup avoids peeing on newspapers of older dog

E-MAIL NO. 1 FROM OVERSEAS TO DR SING

On 1/23/08, ...com> wrote:

Hi,

I read your notes on paper training more than one dog at a time.
I have a 6 month old American Eskimo who is paper trained in my daughter's room, she also has access to kitchen and my work area in the basement I noticed when she needs to use the bathroom she goes back to my daughters room upstairs and use the paper. She also shows signs of going to the door to go out.

Last week we purchased a Pek-a-poo, 3 months old male, however, he does not want to use the same paper even when cleaned and dry, he wants to do his business around the paper, on the floor under my daughter desk. He is confined to her room. I work from home part-time or 3 days a week. Any suggestions?



REPLY FROM DR SING TO E-MAIL NO.1

Subject

Re: Paper training more than one puppy


Thank you for your e-mail. I just read it today Jan 29, 2008 and hope it is not too late to reply to you with some tips.
Pl e-mail to judy@toapayohvets.com as I seldom access the gmail.com

Pek-a-poo 3 months, male puppy.
1. Do you know where he eliminates in the previous residence? Was his toilet area the tiled floor? If that is the case, he is conditioned to the feel of the tiled floor and
so he avoids the newspaper no matter how clean. Newspaper may feel not right to his paws as a toilet area. He has had never eliminated on newspapers before.

If you want to paper-train him, you will need to confine him in an exercise pen/small area in the daughter's room. Cover the tiled floor with 100% newspapers for around 2-4 weeks. If he does not shred the newspapers,
observe which corner he eliminates. You may also place the 2nd piece of a soiled newspaper with the Pek-a-poo urine to attract him to go to the newspapers in a particular corner.
Reduce the newspapered area to that corner where he eliminates. His clean area will be his sleeping and eating/drinking area which may occupy
50% of the tiled floor exercise pen.

Use white vinegar:water 1 part to 3 to neutralise all urine smell on the tiles of the floor of the exercise pen except for the area he is supposed to eliminate.
Feed him regularly and let him eliminate or poop before you allow him out. No distraction. Success in paper training varies from 2 - 8 weeks in Singapore. Much
depends on the owner being there to change soiled newspapers often and to praise and reward with treats when he eliminates.

Do let me know if you receive this e-mail and also your success result.
Best wishes.


E-MAIL NO. 2 FROM OVERSEAS TO DR SING

To: judy@toapayohvets.com
Sent: Monday, 28 January 2008 11:54:24
Subject: Re: Paper training more than one puppy

Hi Dr Sing, I really appreciate you getting back with me.

After reading several of your articles and suggestions, I realized that my daughter and I needed to replace the soiled newspaper more often. Ginger our White Eskimo has been with us for over 3 months, she is 6 mos old and my daughter was a bit lazy cleaning behind her so the Pek-a-poo decided to go elsewhere on my wood floors. So now that we replace the paper as soon as soiled, the paper is now on a first come first served basis.

My daughter has a extra desk in her room, the Pek-a-poo prefers to go under the unused desk and we don't have a problem. Thank you for your suggestions. Pek-a-poo has only been with us a week this past Saturday.



CONCLUSION

I hope this case write up will be of use to other owners with 2nd puppy.

All puppies by instinct want a clean toilet area to pee and poop.

In some single-puppy house-holds, the puppy may be extremely clean (cleanliness freak?) and will bark till the owner changes the soiled newspapers. Or the owner is aware of the need to change the soiled newspapers after elimination.

In the case when a new puppy is introduced and need to share the same toilet location, the puppy dislikes going to the soiled toilet area no matter "how clean the newspapers look after the urine has evaporated" as the puppy can smell the other dog's urine. Some owners just remove the poo from the newspapers but the puppy does not want to use the same newspapers again.

The puppy just eliminates "outside the edges of the newspapers". He is frightened by the possibility of spanking by the owner if he eliminates elsewhere and so, does it outside the paper edges. If the owner is not around, he may do it behind the sofa or some corners.

127. Animal shelter medicine - NANAS

On Saturday Jan 26, 2008, I brought two 2nd-year vet students from Murdoch University to visit NANAS during my off-day. I hope that they would learn more about shelter animal medicine and I hope to see Bobby who was relocated from Yishun Fishing Pond to NANAS some months ago by Mr Raymund Wee and Ms Lynda Goh.

Much practical knowledge is transmitted from the older folks to young ones. But they need to record the knowledge rather than be an observer. I seldom see the young ones doing any writing. It is a pity that the two vet students did not bother to write how other vets or senior staff do the work at NANAS.

What drug they use? What is the dosage? How long will the drug take effect? Any side effects?

If they record such "meaningless" data during their visit to NANAS, they record Animal Shelter Medicine and Surgery for their storage of knowledge. When they study veterinary pharmacology in the 3rd year or so, the records will make their lectures alive. Much practical knowledge and short cuts get forgotten in the sands of time. It is quite sad to see young ones not knowing the value of practical knowledge which would help them later in life or in examinations.


I record the following to share with young vets doing animal shelter medicine.

ANAESTHESIA AND SURGERY OF 3-MONTH-OLD KITTENS AT NANAS.

ANAESTHESIA & SURGERY

1. Zoletil 100
2. Xylazine 100 mg/ml 2 ml
3. Ketamine 100 mg/ml 8 ml
Total 10 ml in Zoletil bottle.
Can be used for 50 cat spays and neuter?
0.01 ml /kg recommended? Did I hear this figure incorrectly from Raymond Wee?


In practice, 0.15 ml IM for 1 kg kitten was effective!
5-6 hours after being fed a bland diet.

Compare to my Toa Payoh Vets practice:
Adult cats are starved 12 hours before surgery in my practice. I don't spay cats less than 6 months old. I use xylazine:ketamine IM (0.5 ml IM combination/2 kg kitten). The NANAS combination method uses very little volume (0.15 ml IM/1 kg kitten). It appears economical for mass sterilisation? It seems effective after observing around 8 surgeries.


Milk bladder to empty bladder.
Tongue pulled out. I see that the tongue is bright red in colour with this combination.
Eye ointment applied to eyes.

Onset: If given IM correctly, less than 2 minutes.
Duration of anaesthesia: Said to be 35 minutes.
Spay surgery: Should be done in 15 minutes.

Incision: Anterior and around 1 cm from the last pair of mammary glands. Sort of divide umbilical area to last pair by three 1/3. Use the posterior most 1/3 area to incise the linea alba. This incision is just above the bladder. Therefore and in any case, all muscle layer must be pulled up before stitching. Otherwise, the bladder is punctured by the stitching needle.

In adult cats, the incision is also around that area. It can be quite difficult to ligate the ovarian ligament as the incision is too posterior, in my opinion.
As for me, I incise about 1 cm from the umbilical area and find this spot the best.

ANAESTHESTIC DRUG COMBINATION IF ZOLETIL 50 IS USED.

1. Zoletil 50
2. Xylazine 100 mg/ml 1 ml
3. Ketamine 100 mg/ml 4 ml
I presume this will be sufficient for 25 cat spays and neuter?


PAIN MANAGEMENT

Tolfedine ? I need to check on this drug.


0.3 ml SC given at the end of surgery. Apparently, the kitten or cat eats the next day. No pain. This is a non-steroidal anti-inflammatory.

ANTIBIOTICS
Amoxycillin suspension 0.5 ml SC.
I don't give antibiotics to cats after spay generally and seldom have complaints of fever. Cats eat after 1-2 days usually. But if pain management is used, they may eat a few hours after surgery based on feedback from NANAS?

3-MONTH-OLD PUPPY
Uterine horns will be 1/4 size of kitten of same age.
So, it will be very thin.

Incision should be one finger's width from umbilicus, not so posterior as in the kitten.

Bladder is expressed in a different way, said Mr Wee.

Will need to learn more about the NANAS method which has been shared by various vets from animal shelters in other parts of the world.

E-mail to judy@toapayohvets.com if you have any feedback to give to me.

127. The Golden Retriever puppy vomited and purged over 10X

"For the past 2 weeks, she was all right. Then on Sunday, she vomited all her food and passed blood in her stools. Later there was no blood but she kept purging more than 10 times. Now she would not eat."

The puppy's stomach and intestine were full of gas.

"No new food or treat were given" the owner was insistent when I asked him many times over the half an hour. "The puppy goes to my office and there is nothing in the room. All my employees know that they don't feed him any chicken rice or any chicken. During exercise in the field, I observe her and she did not eat grass or soil."

Yet the puppy had this serious vomiting and diarrhoea. She was wagging her tail while standing on the examination table. Temperature was 38.8 deg C which was not very high fever.

I asked the owner again, "Any new product you purchased on Saturday or Friday?"

He shook his head. He was so sure that the puppy had gone to the Pasir Ris to play and swim. She had her 3 vaccinations done. Parvoviral infection was unlikely but could not be ruled out.

"Did you introduce new food or something to her?"

Finally, after more than 30 minutes, the owner recalled that the pet people had recommended the rawhide doggy bone. This was because the puppy ate all the previous dog treats.

"The raw hide doggy bone is more lasting and not chewed to pieces," the owner said. "That was on Saturday. The puppy chewed it in the afternoon on Sunday. It was durable, as the seller recommended.

The Golden Retriever had vomiting and diarrhoea a few hours later and on Sunday. He brought her to the vet on Monday morning.

So, the most likely cause of this acute gastroenteritis was the rawhide bone. It took so long to get this info!

126. Toilet training a pup who wants to be clean. Advice from the vet was good.

The Spitz X does not want to eliminate inside the $400 stainless steel crate with a grating and pee pan. The puppy tries to hold his bladder as he considered the crate as his den (clean area to sleep and eat).

So, after meals, a family member will tether him in the kitchen and wait for him to eliminate. When he shows signs, the newspapers are put under him. However, he will frequently eliminate on the kitchen floor.

"He takes a long time to eliminate," the owner said.

"This is due to distraction," I explained. "Somebody is holding a newspaper and watching him. He can't perform under scrutiny and pressure."

I had an idea, "Why not put newspapers to cover the floor of the common bathroom, tether him inside after meals. At least the kitchen floor will not be soiled and smelly and it is easier to clean the common bathroom floor!"

I did not expect the owner to follow up on this advice. When I met her today as the puppy was having pimples in his thights, I asked about the toilet training. She said that the Spitz was successfully paper-trained inside the bathroom. He is nearly 6 months old and he will be passing a larger amount of poop and pee. So, it is good news that he is paper-trained. A lot of stress for the family if he is not paper-trained as he is much loved.

125. Toilet-training - 2nd pup avoids newspapers

E-MAIL TO DR SING FROM OVERSEAS


American Eskimo - 6 months. Paper-trained in daughter's room. Will go to her room whenever necessary.

New Pek-a-poo pup - 3 months, male. Avoids newspapers as a toilet area. Elminates outside the papers or on the tiled floor under the daughter's study desk.

How to solve the problem?

1. Check history of Pek-a-poo. Previous owner must have had trained him on tiled floor and other surfaces. Definitely no newspapers. So the new owner is unsuccessful in paper-training him. Furthermore, there is no urine smell to attract the pup to use the new newspapers.

2. To paper-train this pup, need to confine him to a small area or exercise pen in the daughter's room as follow:

124. The dog that the Singapore Tzu Chi Fundation volunteers saved from lethal injection. Follow up to Case 110.

"Since the dog may die on the operating table, put the dog to sleep," the dog owner wiped tears from his face. I had told him that the dog had less than 50% of surviving the anaesthesia.

The dog had not been eating for the past few days after the first consultation. The dog had been given antibiotics and the owner had not phoned me to schedule the surgery some 10 days later. The surgery and transportation of the dog would be paid by the Tzu Chi Foundation. Yet there was just absolute silence from the family.

The Singapore Tzu Chi Foundation Medical Secretary, Ms Ng had e-mailed to ask whether I had followed up on the case after the first consultation. She was the one who contacted me initially about this dog too.

I told Ms Ng that the family had to decide themselves. I could solicit the family. So, nothing happened on the owner's side. Ms Im and her volunteers numbering more than 10 had helped to bring the dog to the surgery during the first consultation. She and her volunteers contacted the owner and the dog came in for surgery in a worse condition than during the first visit. The dog could barely stand up.

"Are you sure that your over 70-year-old mother had agreed to euthanasia?" I asked. This dog was close to his mum and there was no way I could verify that all family members consented since the mum did not make it to the Surgery.

"I represent the wishes of my family," the man in his fifties was ready to sign the consent form. The Tzu Chi Foundation volunteers were shocked at his decision. Though there was a high anaesthetic risk of dying on the operating table, there was a probability that the dog might survive.

By euthanasia straight away, this dog had no chance of survival at all. One Tzu Chi volunteer, a lady in her late thirties and working for an advertising agency sat beside the dog owner and talked to him.

She talked to me. There was a surgery consent form informing the owner that he knew of the anaesthetic risks. This was a standard surgery form used in all hospitals to confirm in writing that the person had been aware of the risks. The clinical outcome of this case would be so poor that I would rather not risk my professional reputation to operate on this dog. A death of a dog spreads like wildfire to all family members and friends and all Tzu Chi Foundation members. Why take risk of ruining my hard-earned reputation over the years?




The owner agreed to the surgery after much discussion from the Tzu Chi lady. I put it on drips and operated the next day. The dog survived. The Tzu Chi volunteers prayed hard, according to the lady volunteer who spoke to the owner. Killing a life is never an option with the Buddhist volunteers. If there is a chance of survival, take the chance. Some 20 volunteers came to the Surgery to transport the dog back and forth and to see him. These volunteers are not paid by the Foundation. Their intervention save a dog from lethal injection which would have had happened.



Some 6 weeks passed. Did the dog survive after the surgery? I had not phoned the owner. If the dog survived, she could live for a few more years.

I asked Ms Im who reminded me that I had not billed the Foundation for the services. This Foundation is good at accounting and pays for services rendered.

Did the dog survive? Is she fatter? I asked Ms Ng.

Ms Ng said in her e-mail:

Follow-up on Jan 26, 2008

Hi Dr. Sing,

I heard from those who paid visit to see the dog and the owner. The dog looks good and better now. Thanks for your concern.



黄燕芯

慈济新加坡分会

电话：65829958 分机：204

This seems to be an incredible story. When the vet thinks the dog that is emaciated and weak has little chance of survival on the operating table, the dog proves the vet wrong and the owner will remind the vet of his bad prediction. When the vet thinks the dog has no problem under anaesthesia, he dies.

123. Apple cider vinegar to treat kitten ringworm?

After surfing the internet, the owner of the Ragdoll kitten applied apple cider vinegar all over the tail and infected neck of the kitten, as advised by the internet information. The kitten was furiously trying to groom herself to get rid of the apple cider vinegar and started to lose weight.


Ringworm is a fungal infection of the skin. Itching, redness, peeling of the skin.

1. Ringworm thrives under warm moist condtions. Keep the kitten dry.
2. Clip coat short to discover where the ringworm lesions are.

3. For kitten and cat ringworm, do not use human alternative medicine to treat ringworm. These are:
3.1 Apple cinder vinegar soak. Make sure to dry your infected area with a clean towel.
3.2 Tea tree oil twice daily to the affected areas using a 25%-50% solution of tea tree oil twice daily to the affected areas.
3.3 Garlic, a strong antifungal agent boiled to make a garlic bath or solution. Then soak the fungal area.

4. If the fungal araas become red, hot and swollen or the blisters ooze pus, the areas are infected by bacteria. See the vet for antibiotics.

In the first place, it is best to consult the vet. In the case of the Ragdoll, I had it bathed so that the yellow apple cider vinegar solution was washed off. Treated it with antifungal tablets and wash. The kitten responded well. The owner had been given the drugs earlier but decided to use apple cider vinegar. For ringworm treatment, it takes at least 20 days before you can see signs of recovery. There is no fast treatment.

Negative reinforcement training - puppy toilet training

Toilet training is a headache for most puppy owners all over the world. So many real-life factors adversely affect the learning of the new puppy.



----- Original Message ----
From: Name given
To: judy@toapayohvets.com
Sent: Saturday, 12 January 2008 7:21:03
Subject: Appointment

Hi,

I chanced upon your website. I would like to arrange an appointment for a checkup for my puppy. I think it has had his last vaccination in November. I believe the dog is about 5mths old now. I would also like to get some de-worm tablets.

Also, I am having some problem with the toilet training. We had initially taken the wrong approach at just scolding the dog everytime it peed, and now it seems to think that it is wrong to pee, and instead of doing it at the intended area, the dog would only do it when we are not around, in secret. Would also like to get some advice on this. Would like to check if you are available on Sunday 13/01/08 for appointment.


Many Thanks,
(Name)

E-MAIL REPLY

This Sunday, I will be on leave. Next Sunday will be good and we can talk about toilet training as regards your puppy. Each case is so much different as the players (you and family) and environment (housing etc.) varies!

121. Intern sprayed water onto client's T-shirt

The 4th year vet student from Sydney University observed how I flushed out the ear wax from the Maltese ears. The two Malteses were on a grey table outside the Surgery. The lady owner and her 12-year-old talkative son were helping out.

I handed the 20-ml syringe to the intern as I presumed it was a simple matter. She squeezed the syringe perpendicular to the ear pinna. The dog could have moved her head suddenly as the owner insisted that no muzzle be used while she held onto the dog's mouth with her hand.

The 20-ml water squirted and bounced onto her spectacles. Worse of all, the water wetted the white T-shirt of the stern-looking lady owner! It was distressing for her but she was a good sport.

The owner did not complain but she was not smiling. I did not know what to say or where to hide my face.

To irrigate the ear well, the syringe must be held at an angle, not perpendicular to the entrance of the vertical canal.

I just read in a 8-Days Dec 13, 2007 magazine about an expert giving tips on make up. To blend the make up well, most brushes should be held at an angle, and not perpendicular to the face.

Same with the irrigation of the ears of the dog as well!

120. Tethered Silkie not toilet-trained

The Silkie of 4 months, neutered recently, was tethered to the kitchen sink pipe but could not be paper-trained and is not putting on weight. Why?



There was no problem with the weight. The puppy was not thin. The tether method was not successful in this case for the following reasons:

DISTRACTION
Too much distraction from the family members wanting to play with him. He wanted to play and is let free in the apartment. So he does not know why his toilet location should be.

NO FIXED ROUTINE
The puppy was fed various brands of food as he is picky. When he stops eating a brand for a day or two, the owner buys another brand. Then he stops eating again and is offered another type.

PROPOSAL
Buy a crate with wire flooring and pee pan below and confine the puppy for 2-4 weeks. Feed regularly 3x/day and take away the food after 20 minutes. I doubt this puppy can be paper-trained so easily. Will follow up.

119. Follow up on 108: An excellent vet-client relationship is important

The Angora Rabbit keeps losing interest in food. After the veterinary treatment, ate for 3 days and then stopped eating. Why?

Nothing specific during the consultation. Thin as a rake, loose stools, teeth grinding. Something had affected the digestive system. The rabbit was not losing hair. Just very thin and not eating much.

I had presumed that the rabbit would be eating hay and food pellets as other rabbit owners but I was mistaken. I asked the owner to send me some pictures of the rabbit at home.

The young lady sent some pictures of the rabbit's housing via e-mail as requested by me. From the pictures, this rabbit was very well cared for. It appears that the lady in her late twenties piled hay on top of the pellets in one feed bowl. So, the rabbit ate mostly hay and no pellets or little pellets. Over some months, this could be an imbalanced diet and there also could be toxins in the hay? Toxins not enough to kill the rabbit but did cause some loose stools.


Dec 22, 07
The owner noticed that the rabbit was not eating again. She text messaged for appointment. The rabbit ate a bit and she might sms to cancel the appointment.

The rabbit came the next day. She was warded for one day for observation and fluid therapy. The rabbit was given pellets and vegetables. She liked the leafy kangkong vegetables.

The owner was advised to give her a variety of diet and to get new hay from another brand. She bought the branded hay. The hay has to be put in a separate bowl.

"Pesticide free vegetables are best," I said. "Only certain supermarkets sell them and you need to look for them."

The rabbit was given a variety of food including apples. "Apple skin only," the lady said when I sms her one day. "She gets diarrhoea if given the apple itself."

"Apple skin may contain pesticide," I advised her not to give the skin as apple growers nowadays spray insecticide all over the apples to prevent insect damage. I did not know what she would be doing to source the pesticide vegetables. Christmas and New Year passed by fast. Then I got an sms from her on Jan 5, 2008.



Jan 5, 08

Sms from the owner.

Hi Dr Sing, how hv u been? To update u, I hv been feeding (name of rabbit)with pesticide free lettuce leaf n a mini carrot daily. She continues wif her new pellet n hay diet. She improves a lot n now i can feel her little tummy. She looks good. Thank you so much for your continuous care & attention.


It is important for the vet to follow up in cases where the pet is eating less and less everyday. The feeding management of the pet might be at fault rather than the disease.

With text messages nowadays, it is much more convenient rather than phone calls.

As this young lady owner has an excellent professional veterinary-client relationship, it was easy to follow up via sms. Sometimes I had to phone her for more details as sms can be quite brief.


If this case was not followed up by the vet and the owner had not bothered to e-mail pictures of the rabbit housing, the rabbit probably would have had died as she ate less and less.

This rabbit does not suffer from anorexia nervosa unlike young Singaporean girls. Most likely, the hay was toxic and the variety of diet was not eaten.

118. Hamster tumour - Teaching the intern

"No anaesthesia?" the 2nd-year Murdoch Univ vet student asked me. All animals must be anaesthesized before surgery to avoid causing pain. This is generally observed by all vets as we don't want the animal to suffer.

However, in this case, the hamster was thin and not eating a lot. She had this glistening big skin tumour for some time and was not eating when brought to the Surgery. A dose of anaesthetic gas might kill her. Could not walk properly as the tumour irritated her. Probably could not sleep well too.



All clients want a live pet back after treatment. Death of a pet ruins a reputation of the veterinarian whatever the explanations.

In this case, the risk was extremely high. I noted a short stalk attached to the "tumour after 3 days of hospitalisation. A small scissor with curved blades snipped the tumour off in less than 1 second. The hamster would still be alive.

After snipping, blood splashed covering the whole area of more than 2 sq cm. What to do? This tumour had a large blood vessels connected to the skin. Would the hamster die? The young student held the hamster in the towel while I pressed a piece of tissue paper to stop the bleeding.

Bleeding is quite common in tumour removal of hamsters. They looked profuse and a lot because the hamster is so small, unlike a dog. It was not possible to clamp the stalk of the tumour as the tumour itself was small. The stalk was about 2 mm in width and because the tumour was no longer inflamed, I could see it.

If I had operated on day 1, I would not have had seen it. The hamster might not have survived as she was in a poor condition. Never operate on a pet that is not eating. Minimise the risk of death due to stress from surgery.

"The fastest way to wash away the blood was to flush the blood off under a tap. Just the area of surgery and not the whole hamster", I said to the student who had not spoken one word throughout the surgery. He must be wondering how I could wipe the messy bleeding as the hamster struggled to get free.

I don't know whether the young man learnt anything from this case as he was starting his second year. Did he learn something about the anatomy of the hamster's reproductive system.

"Is the tumour an enlarged clitoris?" I asked him.

"No," he said. He was correct. From close observation, it was a skin tumour very close to the vulval lips but definitely not the clitoris.

Is he the observant type I wondered? Why was the tumour located in relation to the vulva?

I asked him to illustrate the process of cutting the tumour as he saw it so that he could learnt something by participating in the whole procedure. He was a good illustrator.

The young man drew the tumour at the right side of the vulva.

"No," I said. "The location is not correct." I let him see the wound as he held the hamster. The location was now correct and he drew the illustration for me to include in the case study.






Hamsters are beloved family pets and the family was most happy to see her alive and without the tumour.