Sunday, April 19, 2015

*A Shih Tzu keeps having eye discharge

Sunday Apr 19, 2015

"His left eye keeps discharging thick pus daily" the lady had consulted a vet 2 weeks ago. The vet prescribed eye gel and eye drops and advised normal saline eye wash daily. "She said the dog's eye would recover soon."

"Did the vet really guarantee that?" I asked.
"If not," she replied. "I should go back to her again. But I am not doing that!"
"When was the left eye injured?"
"About 2 to 3 months ago." she was not sure of the exact date. She had been treating the eye injury with eye drops herself but the eye got worse.
"Shih Tzus have protruding eye balls," I said. "The eyes get injured easily, becomes ulcerated and scarred. Eye injuries are emergencies. Treatment by the vet should be done within 24 hours to prevent scratching of the eyes. Did the vet advise an Elizabeth collar to wear?"
"No," she said.
"The left eye cornea is dull compared to the right eye," the owner noted the scarring.

Dr Daniel sedated the dog, got the hairs around the face and ears clipped off so that the eyes do not get loose hair irritations. The eyes were irrigated with saline. The 3rd eyelid was elevated to flush out any hairs and debri. I gave a subconjuctival injection of antibiotic and anti-inflammatory. The dog went home with eye drops and a dry eye ointment as well as e-collar. He will have to stay away from the wind and sun and wear the E-collar 24 hours daily for 2 months. There was no deep corneal ulceration based on fluorescein stain test.

I cannot guarantee normal tear production as the owner had delayed seeking vet treatment for 2-3 months. It is hard to predict the outcome as to whether the eye will recover fully.  To follow up in a month's time.

A Shih Tzu's eyes are most easily injured. Treatment within 24 hours by your vet is important to save the eyesight.     

Friday, April 17, 2015

1172. A rare case - A cat has jet black anal sac oil

Sat April 18, 2015  11 am

"The ferocious cat will never be injected or examined," I said to the mother and daughter who tried to coax the cat out of the carrier. The cat hissed warnings but they ignored her.
"Once out of the carrier," I advised. "The cat will bolt and be even angrier!."

"This is a country pumpkin cat," the adult daughter said. "She has never gone out of the apartment." Her brother who loves this cat very much was at work selling outdoor exercise equipment. The whole family loves this angry cat.

It was 2 years ago that she was spayed and I did not see her again for the annual vaccination last year. "Too busy," the working daughter said. But in the past 3 months, the cat was losing hair on both flanks.

"It is just not possible to examine her as she will scratch anyone approaching the carrier," I advised giving the cat isoflurane gas and oxygen anaesthesia. This was done and the cat was examined. Hair loss of 50% on both flanks due to licking.

A case of bilateral endocrine alopecia since she was spayed by me 2 years ago? Flea bite dermatitis earlier as there was no signs of fleas. A case of anal sacculitis which is rare in cats.

As the cat was sleeping, I pressed the anal sacs. Jet black oil oozed out in copious amounts (see video). More  dried grey granular oil ssquirrelled out from one sac and the owners could see the oil.

"The normal oil is light yellow, like cooking oil," I said. "Your cat's black anal sac oil is rarely encountered.  One in 1000 cats possibly. The cat could feel the itchiness in the anal sacs and alleviated her itchiness by licking the flanks.

The oil was expressed.
"Her stools may be too soft and so, the anal sac oil could not be discharged," I asked whether the owners had seen the stools.
"No," the daughter said. "The maid cleared up the stools."

This was a beloved cat who would growl and hissed at family members too. So the mum clipped her claws two at a time when the cat was sleeping.


This cat came for a check up for the hair loss early. I noted in my record that the anal sacs were OK 2 years ago. So, this problem of anal sac impaction happened in the last 2 years. 

Jet black anal sac oil is very rarely seen in cats and so this will be considered a rare case. 

Tuesday, April 14, 2015

1170. Schwannoma in a 10-year-old Miniature Schnauzer

April 13, 2015

This male 11-year-old Miniature Schnauzer had a big grey skin lump, 1.3 cm x 0.8 cm x 0.7 cm on the skin of his toe. It could be a melanoma. Dr Daniel suggested excision and histology.

Histology
Benign peripheral nerve sheath tumour suggestive of schwannoma. No evidence of malignancy. Good news. Otherwise, the toe will need to be amputated.

VIDEO

MY OPINION
As the dog is old and the growth is greyish and growing "fast", the owner should be given an alternative surgery - excision of the digit (toe) in case the tumour is malignant as there is not sufficient margin to remove all tumours.

In this case, "some of the spindle cells ae seen to reach the deep resection margin focally" meaning that the whole schwannoma could not be excised fully. There is a possibility of recurrence and a need for toe amputation later. The owner was aware of this possibility.

1169. Deep spreading pyoderma in a young female pug

Signs
Pustules on chin, nose and ears first  --- chin acne or nasal pyoderma. Ear pustules.

Skin scraping - demodectic mites and dermatophytes  ----- No demodecosis, dermatophytosis yes No bacterial culture and sensitivity done to lower costs

Spreading. Very itchy

Skin biopsy on collarettes when lesions get more - ruptured epidermal cysts --- pyogranulamatous processes
No fungal culture
No cytology

Ciprobay, ketoconizole, amitraz wash, atopica, pred at different times.
e-collar, booties for hind paws, pain relief.

Healing after more than 4 weeks of treatment
Folliculitis or impetigo?
Deep spreading pyoderma


Tuesday, March 24, 2015


1146. Pug with folliculitis

Mar 24, 2015
Review of the pug. 9 days. Still has inflamed skin. Appeared spreading.
Ringworm +ve some hairs
Skin scrapings 3 areas - no mites seen.
Allergy?  Plastic biting of handles of mum's bedframe - allergic on chin and face.


LOOKS VERY MUCH LIKE
COMPLEX DEEP PYODERMA - seborrheic conditions - follicular and sebaceous disease.
A skin biopsy showed ruptured epidermal cyst - pyogranulomatous inflammation.

A very difficult skin disease to treat with antibiotics in this pug as the pyoderma keeps spreading and the pug keeps scratching every day uncontrollably.  



Skin biopsy is important in this case. Report
 -- ruptured epidermal cysts

VIDEO AS AT APRIL 12, 2015    MORE THAN 4 WEEKS OF TREATMENT OF THE DEEP SPREADING PYODERMA. Not fully recovered yet. Will the pustules and collarettes recur?






armpit left side - infection caused by left hind leg traumatic scraching  ---foreign body material like plastic and hair keratin scratched into the dermis --- collarettes?

Still has 7 days of medication and on amitraz wash. Appears to be healing now. Owners are happy.


FLASH BACK
FIRST VISIT
PUSTULES AND COLLARETTES








APRIL 14, 2015
Always palpate and press the skin lump. It was painful as the pug reacted to palpation. I suspected an abscess. Histology report of skin lump from central sternal area - acute suppurative inflammation and abscess formation. Noevidence of malignancy. 




1168. How to examine a Beagle's swollen closed eye?



Yesterday, Apr 13, 2015, a gentleman brought in a Beagle with the left eye swollen and closed 90% while the right eye was 60% closed. Both eye conjunctiva had bulged and swelled to a large soft mass. What was the cause? He had been barking the whole night.

"I suspect that some naughty  had splashed chemicals onto his eye or he had contacted such chemicals from the fertilisers or plant."


"My Beagle is leashed and so it is not possible for boys to do it," the man said. "Besides, I live in a very good neighbourhood."

"It is possible that there are naughty boys who splashed acid onto his eyes," I replied. "There are always the fringe extremes of human behaviour."

FOR VETERINARY EXAMINATION OF THE EYE - SEDATION, EYE WASH, FLUORESCEIN EYE STAIN TEST

Dr Daniel sedated the dog and gave an IV drip with dexamethaone and baytril. The conjunctiva had reduced much in swellings after the use of 0.1 ml of dexamethasone as you can see in the images..



    

The white debris are hairs. A video shows clearly the fluorescein stained green corneal ulceration. The next day, the owner came to visit. Swelling of the right eye had subsided by 90%. Should go home tomorrow.

The dog could have splashed himself with cleaning detergent as he had been leashed near the washing area and mop. So, there was no naughty boys.

BLOOD TEST
Significant finding is low platelets  106   (200-500) indicating that there was toxaemia.
The white cell count is normal  11.9 (6-17),  N 74%  (60-70%),  N absolute 8.8 (3-11), L 19%, L absolute 2.21, M 4%, M absolute 0.45%, E 3.9%, E absolute 0.46, B 0.1%, B absolute 0.01


DAY 2
He looked much better today. The image was taken when he was sedated to check his eye ulceratios. The left eye was normal.

DAY 3
Left eye cornea no longer stains green with fluorescein indicating that the corneal surface is not ulcerated. However, I can see faint cloudiness in the central area.

The left eye white (sclera) is severely congested indicating that there was severe inflammation and pain when the chemicals spill over the left cornea.. E-collar is applied.  VIDEO

Dog goes home with painkillers and eye drops.

Saturday, April 11, 2015

1167. Miniature Schnauzer has itchy flanks again and again - ear pain or bilateral endocrine alopecia?

"What is the solution?" the lady asked. "In any case, give my dog the anti-itch injection."
I did explain to her that an ear surgery may be needed to provide ventilation and drainage as the ear pinnae showed hyperpigmented markings of chronic scratching. She said I had not mentioned it before. I showed her the illustration I had in her case file, of the ear surgery called lateral ear canal resection.

It is good practice to illustrate the surgery and keep a record. Owners have short memories and in this case, I had the evidence of having explained to her. Another cause could be bilateral endocrine alopecia.

VIDEO