Monday, April 21, 2014

1356. An old pug X in the quarantine had black turbid urine

On Sunday, I received a phone call to treat a 12-year-old pug X in the Sembawang Quarantine.  I asked Dr Daniel to do the house-call but the Quarantine is closed on Sundays.

"Bring along a container to collect the urine," I said to him. Usually, no urine is collected as the vet just gave the antibiotic injection.  He went on Monday and got a bottle of black turbid urine. Black urine indicated a serious infection. 

Today, April 22, 2014, I phoned the Quarantine. "No blood seen in the urine," AVA officer Bong told me. I phoned the owner at 11.45 am to tell her the results of the urine test. She said: "The dog is much more active today, after the injection."

Urine black, turbid
pH 9.0  SG 1.005, Protein 3+, Blood 4+, WBC & RBC >2250, Crystals triple phosphate occasional, bacteria 3+

ADVICES TO OWNER
1. As the dog still has 3 weeks in quarantine, the infections of the bladder may return.
2. S/D diet is recommended if the urinary stones are small, but no X-rays can be done yet as the dog is in quarantine.  S/D diet will not dissolve the stones if they are large and X-rays are needed to confirm.
3. The owner decides to wait and see.  S/D diet does acidify the urine too preventing recurrences to a degree. It is hard for the owner to understand the factors causing triple phosphate or struvite formation including an alkaline pH of 9.0 and bacteria urease.  

Saturday, April 19, 2014

1355. 7 small bladder stones in a 12-year-old Miniature Schnauzer on Good Friday

April 20, 2014

"The stones are so small," Dr Daniel commented from the X-rays taken on April 19, 2014, a Good Friday which was a working day for me. "They can be dissolved using dietary management as in Gatsby who was fed S/D diet and is now OK, without any surgery required." The biggest stone was around 4 mm across. Not the usual big pebbles. 

"Each dog is different," I said. "I have not seen Gatsby's X-rays and any routines and instructions on the on the dietary dissolution of stones must by complied by the owner.  Yesterday, you unblocked the bladder. The urinary catheter came out when the owner's daughter visited. This morning, the parents came. The dog lifted his leg and no urine came out. So, his urethra was blocked again. The parents consented to surgical removal and I had advised on the high anaesthetic risk of dying."   

Yesterday, on April 18, 2014, this 12-year-old male, not neutered Miniature Schnauzer came with a history of not eating for the past two days. "He had never been sick in his life," the wife told me. "He went to Vet 1 for the usual vaccinations, but 2 years ago, he passed blood in the urine. Vet 1 gave me a course of antibiotics, saying that this dog was too old for anaesthesia and if the medication worked, there would be fine. And he had no more blood in the urine since then!"

The dog was lethargic but had no fever. His body smelted strongly of urine. The stench of urine not easily washed off by bathing as he was incontinent. I suspected urinary stones as Schnauzers are prone to this condition. I palpated the bladder. It was as full as an orange. "Is he able to pee normally?" I asked the maid. "No," she shook her head. "Very difficult and urine drops here and there."

Dr Daniel would unblock the bladder. He commented that the bladder would not be obstructed but I said it was. Only urethral catheterisation confirmed my findings. 

Dr Daniel flushed the stones back into the bladder and removed. I noted the surgery took around one hour. The bladder was bright red and inflamed. The bladder wall was 5 mm thick. He stitched the mucosa and the wall.

On April 20, 2014, now, a Sunday, the parents came in at 9.30 am after breakfast. The dog was jumping for joy inside the cage. I showed them a video of the dog peeing freely outside the clinic, plain yellow urine without blood, taken just 10 minutes ago. 

The parents wanted to take an image of the dog active with their handphone for their 26-year-old son studying in England. "Take a video," I advised and got the container of the small urinary stones for the mother to video.

This story has a happy ending but it is not guaranteed as the dog was 12 years old and lethargic.

Blood tests showed high total white cell count and neutrophilia as follows:
Total white cell count 28.5   (normal 6-17)
Neutrophils  95.5 %    (normal 60-70%).
Neutrophil absolute 27.2  (normal 3-12)

Urine tests
pH 9.0, protein 2+, blood 4+, white blood cells 33, red blood cells >2250,crystals triple phosphate +

MY MANAGEMENT OF THIS CASE
1. Fluid therapy 2 bottles of Hartmann and dextrose saline  + amino acids and glucose IV
2. Baytril + Spasomogesic for first day.

3. Fluid therapy during surgery.on 2nd day. The dog was much more alert.
4. X-rays x 3. First X-ray showed stones in os penile urethra. I had a the dog's bladder evacuated of dark red turbid urine and given 20 ml of air to get two better X-rays. The two bigger stones were obviously seen as a guide to the operating surgeon Dr Daniel who took out 7 small stones. 
5. Stones for chemical composition.
6. Dog to be warded for 7 days.
7. Bad teeth with thick crusty tartar should be removed 7 days later.

It is likely that this dog will be OK. Medical dissolution of stones was not realistic as the dog's penile urethra keeps getting obstructed and the dog was incontinent and dysuric. The first vet had not taken any urine tests but just prescribed antibiotics which cured the blood in the urine. It will be good practice to get the urine tested in cases of haematuria but owner economics or the vet's personality might not lead to this practice being done.  

Thursday, April 17, 2014

1353. Youtube videos at www.toapayohvets.com

Nowadays, most case studies are posted as videos as they are more interesting for the viewers. See www.toapayohvets.com for the videos.

1352. A Golden Retriever collapses suddenly - stroke or heart attack?

April 16, 2014 7.30 pm

Goldie, the Golden Retriever, Male, 10 years ate his food at 6.30pm as usual, after being outdoors. 15 minutes later, he could not stand up. Just lay down on his chest for he next 15 minutes. So, the owners brought him to see me at around 7.30 pm. The parents, two grown up sons and two lady friends came, together with a plastic folder of the dog's past medical records.

"The dog can walk now," the father said. In fact, the dog had leaped off from the back of the small van, as usual. "Could he be having a stroke?"

I got the dog weighed and the rectal temperature taken. No fever.
"His gums are very cold and cyanotic," I could feel the chill in his gums, an unusual feeling. I pressed his spinal area from the neck to the tail. No pain. The dog was standing on the table and showed no pain when I checked the abdomen. A blood test showed nothing abnormal. An increase in SGOT/AST was the only finding. I auscultated the heart. There was a machinery murmur. I palpated the throat and the dog coughed.

"This dog likes to eat from the grass," the mother said. Could he have swallowed some stones?
"He also ate his food very fast, all in one go," the mother told me. So could he have choked himself?
The dog was quiet and laid down on the table, as if he was very tired.

So, what's wrong with this dog? With scans and ECG tests, this would be hard to say. I treated him for a  heart disease with Fortekor 5 and Lasix tablets to be given once orally for 2 weeks..The dog was very lethargic as he preferred to lay down on his chest. But he leaped onto the back of the van.

"What drug did you give him," my nurse Julia asked. "He was lying on the waiting area after treatment and was breathing hard. Yet on gong home, he leaped onto the back of the van!". This dog does that when he is healthy as he leaps on and off the van during outings..

April 17, 2014
The next morning,  I phoned. "The dog is 70% more active and has eaten all his food," the father said.
In the evening, I phoned. "The dog is standing and walking unlike yesterday," the mother said as the father was out playing badminton. "He is 10% better. When he came home from Toa Payoh Vets, he was so tired and just lay down the whole night."
"Has he eaten all his food?" I asked.
"Yes," she said.
"Did he drink water, pass stools and urine?"
"Yes," he did. "He drank water, but no stools. He pees outdoor and so I don't know."

So what is the cause of this dog's lethargy after dinner?
It is very difficult to say. I would consider that, since he swallows his food very fast since puppyhood, he could have choked. A small piece might have gone into his lungs and the lungs shut down in reflex protection. So he was not able to stand up for 15 minutes after surgery. Or he could have a heart attack or stroke. For reasons of medical costs, no further tests were done.

A very strange case as his blood test showed all values normal except for an increase in SGOT/AST. This might not be significant. A review 2 weeks later would be needed.

Monday, April 7, 2014

1351. Biopsy of breast tumour in an old cat

Female cat, spayed 12 years.

Right armpit area - a lump was detected and excised by Dr Daniel in Oct 2013. The owner stated it was a cyst. To me, it looked like a skin tumour and I recorded this down. No histology was done.

On April 5, 2014, the owner came with the cat not eating and a bigger lump. Now, around 4 cm x 2 cm x 1 cm. He wanted a biopsy done by Dr Daniel and sent to the lab.

Results from the lab
2 strips of tissue 1.0 cm x 0.4 cm x 0.2 cm.   

Diagnosis: Aypical ductal proliferation suspicious of low-grade ductal carcinoma.  What's App the report to the owner.

1350. Tarsorraphy in 2 Shih Tzus

Some vet books, vet professors and vets are not in favour of tarsorrhaphy. I encountered a recent Murdoch Univ vet graduate who said to me that it is a waste of time.

In this case, Shih Tzu (Shih Tzu 2), male, 10 years, first time corneal ulcer went home on the same day. Today, the 7th day, I noted that the tarsorrhaphy procedure seemed to be successful for the following reasons:

1. Early detection. Probably one to two days when the parents came back from overseas and saw the 10-year-old Shih Tzu with right eye closed. The dog was cared by the daughter.

2. Keratitis traumatic - 3 classifications. Superficial, penetrating and perforating. This case is penetrating unlike the first Shih Tzu (Shih Tzu 1) which is perforating as I saw some anterior chamber watery liquid squirting out and the red basement membrane bulging out, a Descemetocoele.
Both dogs were operated by Dr Daniel.

3. Shih Tzu 2 was closely supervised at home by the retiree parents unlike Shih Tzu 1 who was left alone. He was crated on the first day. Cried to get out. So, the next 6 days, the elderly parents stopped their taiji exercise to take care of him while he roamed around the apartment. They complied with nursing instructions to give eye drops 2- 3 x/day, painkiller tolfedine 60 mg (1/2 tab /day),  vibravet 100 mg (1/2 tab/day 14 days) and multi-vitamins.

4. So, today, they came for a review at the  7th day. Eyelids still closed by stitches. A 2-mm gap is seen rather than loose sutures.

5. The dog was examined and there was no pus inside the eye. A small gap on the medial side allowed eye drops to be instilled. I prescribed Rimadryl 75 x 2 tablets at 1/2 tab per day from tomorrow. Another bottle of eye drops. 2 bottles have been used.

6. The final proof of good surgical outcome will be at the 14th day. Another 7 days later, the stitches were removed. His central ulcer was healed. However he had a fluorescein-green ulcer from 4 to 7 o'clock and pigmentation on the lower left quadrant. "He must be wiping his e-collar on the floor," I said to the retired couple. "He  was supposed to be crated for at least 10 days, but he was free to roam." In tarsorrhaphy cases, it is best to hospitalise the dog but tnis owner wanted the dog home.  


In Shih Tzu 1, the dog was warded for 7 days and crated. Nursing care was given as above. The stitches came loose around the 7th day and were taken out. There was cloudiness in the central corneal ulcer due to corneal edema. This was part of thel corneal healing process. .

Monday, March 31, 2014

1349. Questions regarding neutering a cryptorchid

April 1, 2014

I am Dr Sing Kong Yuen from Toa Payoh Vets. Below are my replies in capital letter to your questions.  


 2-year-old golden retriever with an unilateral undescended testicle who came down yesterday to your clinic. I had listed my dog for neutering next Saturday. However, I have some questions (mainly regarding neutering vs. removal of the undescended testicle, options which were offered to me) that I neglected to ask Dr. Sing during the consultation and was wondering if it is possible for them to be answered through email. I understand that it is ultimately on my informed decision that whichever operation will be carried out, but I would like to have a little more information to make that choice.

    1. What is the advantage of neutering a unilaterally cryptorchird dog over just removing the retained testicle?
I CANNOT UNDERSTAND YOUR QUESTION. RETAINED TESTICLES IN DOGS HAVE A HIGHER RATE OF TESTICULAR NEOPLASIA THAN DESCENDED ONES AND THEREFORE REMOVAL IS ADVISED BY VETS  


    I understand and accept the benefits of neutering in general, but this dog will not be bred, and is not allowed to mount and kept on a leash at all times when going out, and in which case, given that he is unlikely to pass on whatever defective genes to his offspring, is there any added benefit to neutering, especially when weighed with the loss of testosterone secretion and whatever health benefits it may bring with it?

OTHER THAN ANTI-SOCIAL BEHAVIOUR LIKE MOUNTING AND URINE MARKING, NEUTERED DOGS ARE LESS LIKELY TO DEVELOP PERINEAL HERNIAS, PROSTATE ENLARGEMENT AND INFLAMMATION AND CIRCUM-ANAL TUMOURS IN OLD AGE. 

    2. In your experience, is there an increased risk of testicular cancer in the undescended testes? I know that in humans with cryptorchirdism, the undescended testes itself is at higher risk of malignancy, but does this apply to dogs as well? I am unable to find any literature online with regards to this question.
THERE IS LITERATURE ON INCREASED RISK OF TESTICULAR CANCER IN UNDESCENDED TESTES. YOU MAY NEED TO SUBSCRIBE TO ONLINE VET DATA BASE


    3. What will be the effects of neutering on my dog's physique? He is very active and runs ~20km/week with me at quite a fast pace and I would like to retain as much muscle mass as possible. I understand that he is probably physically and sexually mature at 2 years with closure of the growth plates at this point in time, but will there be a detrimental effect on his lean mass? Further, anecdotally I know of dogs whose hair became coarser after neutering. Is this backed by evidence?

I HAVE NO KNOWLEDGE OR SCIENTIFIC RESEARCH TO ANSWER YOUR QUESTIONS

    4. Will there be any changes to his personality/increased risk of depression?
NEUTERED DOGS ARE GENERALLY LESS AGGRESSIVE AND TERRITORIAL IF NEUTERED AT A YOUNG AGE. SOME MAY STILL DO URINE AND STOOL MARKING AND MOUNTING AFTER NEUTERING.   AS REGARDS CANINE DEPRESSION, I DON'T HAVE ANY KNOWLEDGE ON THIS AREA. 

    5. Will there be histopathological examination of the retained testes?
YES, IF THE OWNER REQUESTS FOR IT.

    6. Is there a role for androgen supplementation in a neutered dog?
NOT A ROUTINE PRACTICE IN VET MEDICINE. I DON'T HAVE OWNERS REQUESTING THIS.


    I apologize for the questions and they must sound very tiresome, but I have thought over my options for a long time and feel that I must consult with you for further guidance. Thank you very much and sorry for any inconvenience caused.