Tuesday, July 26, 2016

2984. A repeat X-ray shows lung tumours have compressed the windpipe of the coughing Schnauzer

Tuesday July 26, 2016

This 15-year-old male Miniature Schnauzer was adopted as a 3-year-old and was much loved as evident by the couple seeking a second opinion at Toa Payoh Vets and following up with us to resolve the daily coughing.

"He did cough up blood 2 months ago. A dry hacking cough. I thought it was kennel cough and brought to Vet 1.  Vet 1 did X-rays and said that there could be lung tumours. He proposed $4,500 to do surgery."

So, the couple came to Toa Payoh Vets for a second opinion as they did not want the surgery.

"The dog must have something inside his throat," the husband said yesterday as the dog came in collapsed and coughing. He was warded in a veterinary surgery with 24-hour nursing care overnight and brought back to Toa Payoh Vets today by me.

Dr Daniel proposed a broncho-scope to see inside the windpipe and a vet quoted $1,600 for the procedure.

"Is there lung tumours on not?" I asked as Vet 1 seemed to have said that lung tumours were present but the owner was not sure. I asked for the veterinary report from Vet 1.

"It is better and cheaper to get another X-ray done since the one done by Vet 1 was 2 months ago," I advised. Dr Daniel. The couple agreed and I got the dog X-rays.

The X-rays showed massive lung tumours and pushing up of the windpipe and narrowing of the windpipe.

"More coughing and lack of oxygen in the blood causing cyanotic tongue yesterday indicate that the lung tumours have badly affected this dog compared to 2 months ago,"  I could see the couples' smartphone video shown to me. The dog was not coughing, ate like a horse and was normal lifting is leg to pee in this video taken by the wife in May 2016.  So, that was the reason the couple did not think that the dog had lung tumours.

The repeat X-rays shows the progress of the lung tumours. "It is likely lung cancer since the dog got much worse in the last 2 weeks, could not breathe well due to lack of oxygen in the red blood cells causing cyanotic tongue and nearly died from collapse yesterday. There is the windpipe being pushed upwards by the tumour in front of the heart as seen on the lateral X-ray."

"Is there a cure?" the couple asked.
"No permanent cure even with chemotherapy."
"With chemo, the dog will have a poor quality of life," the wife said. "How long will the dog live?"
"I can't say. Maybe 2 weeks. He had fits and probably metastasis to the brain causing minor strokes yesterday."
The owner brought the dog back to decide what to do.

2983. A British Bulldog cannot open his right side of his mouth

Tuesday Jul 26, 2016

A "miniature" gentle British Bulldog. The young couple came to Toa Payoh Vets for a second opinion. Vet 1 had X-rayed the mouth and declared nothing wrong with it. Yet the dog could not open his mouth fully.

"The problem started after he chewed a pig's ear," the wife showed me a video as evidence. "Vigorous chewing on the right side." This was great evidence.

"Soon the right eye became red," the wife continued. "The right cherry eye popped out of the eyelid later but went back into the eyelid again! So we rushed him to Vet 1. Vet 1 did suggest a genetic problem with the jaw. "

"Yes, there is a dog breed which is prone to TMJ disorder," I said.

Vet 1 proposed an MRI scan which would cost $1,800 but is the gold standard for TMJ disorders. The owners were not keen on the MRI. The dog was prescribed eye drops and meloxicam 10 ml bottle.

The dog could open his mouth around 5 degrees and still could eat and swallow despite this difficulty. So there was no need for a feeding tube nor massage recommended.

I requested Vet 1 to email me the X-ray as the owner was reluctant to get further X-rays of the TMJ (temporo-mandibular joint".


An oblique X-ray would be more useful than the lateral one done by Vet 1.  A dorsal-ventral view of the head would show whether the condyles were luxated or fractured but this was not done.

"At first he could only drool after chewing the pig's ear," the husband said. "That was why we quickly brought him to Vet 1. But Vet 1 said there was nothing wrong with the right side of the mouth."

I got a blood test to check for any toxin affecting the platelets or blood cells since this was not performed by Vet 1.

"It is likely that the pig's ear was preserved with chemicals which seeped into the right side of the mouth and facial muscles," I hypothesized. "The red eye became inflamed and painful. Then the right TMJ jaw joint was 'locked' by spasm of the muscles and nerve toxicity.

Or the vigorous chewing could have dislocated the TMJ partly causing intense pain, hence locking the jaw. The couple was more in favour of the chemical cause.

The dog went home with an anti-inflammatory injection and would be reviewed 2 weeks later.

Sometimes, it is hard to determine the exact cause. As for the MRI, the cost is very high and few owners want to do it as Vet 1 probably could not communicate the value of doing the MRI.

The dog was seen yesterday and was given a pred injection. The course of 10 ml of meloxicam was completed.  The blood test showed liver disorder or inflammation with liver enzymes twice the normal level.  The total white cell count was normal as were the neutrophils and lymphocytes. Why was the liver enzymes raised?  Could the liver damage be due to the toxic chemicals in the pig ear affecting the dog?  The owner would send me a video of the dog chomping vogorously on the pig ear for my intern to produce a video.   

"The dog could open his mouth more and is more active," the wife told the husband as I enquired over the phone.


Good view of TMJ from another dog with no locked jaw.  Mouth is closed. 

2982. Searching for an entropion veterinary surgeon for a Chow Chow

Tuesday July 26, 2016

The 2-year-old Chow Chow was abandoned. He could barely open his eyelids to see and would bang into objects. Thick pus crusted his eyes. The couple who adopted him brought him to see around 6 vets. After consultation, the vets said they did not do entropion surgery.

"You phoned the vets by alphabetical order?" I asked. "Toa Payoh Vets would be at the bottom of the list."

"We googled entropion vets" the wife said. "We did consult an eye specialist but we need to wait for many weeks for our turn."

The 26-kg Chow Chow was particularly nervous and would not sit still for examination. Sedation with Domitor + Ketamine IM at 0.3 + 0.3 ml IM sedated him a bit and a blood sample was taken for health screening before the operation next week. The dog was given the first vaccination as I doubt he had been re-vaccinated since he was thrown out to the streets till adopted by this couple.   

Sunday, July 24, 2016

2981. A 15-year-old Jack Russell vomits and has bloody diarrhoea

July 21, 2016

Two 15-year-old Jack Russells as patients.

Actie outdoors. Goes for walks. Had ticks. 2 days ago
vomitted many times and passed bloody diarrhoea. Lethargic. Cyanotic mucous membranes. . Rectal temperature 37.6 is below noraml.  Had ticks - a big engorged one and smaller one.

Blood test showed high levels of urea, creatinine and ALT. Slightly higher total white cell count and neutrophils with decrease in platelets.

Recently, there are reports of leptospirosis (bacterial infection) in a pet care place's swimming pool and some cases in people.  Leptospirosis is a notifiable disease.

1/18 cases was confirmed leptospira according to a Straits Times report on July 21, 2016. Dogs were either not vaccinated or had no updated vaccination.

This dog had no exposure to rats but had walked in parks. IV drips and antibiotics were given but the dog had fits due to kidney failure. The beloved dog was euthanased as the prognosis for full recovery was very poor.  

X-rays showed enlarged liver and kidneys.
Negative for parvovirus.

"Does he catch rats?" I asked as there were some cases of leptosporosis in dogs and people reported. 
I treated with antibiotics, anti-spasmodic and IVdrips for 2 days. The dog showed fits which was controlled by diazepam IV 24 hourly for last 2 days. But he was unable to stand up. The owner decided on euthanasia.

Vomiting and diarrhoea are very common conditions in dogs. This dog was not boarded but had been to parks. He would have picked up some bacterial infections causing septicaemia. Many owners would not vaccinate older dogs and some do suffer from diseases causing serious illness.

Went to other vets but no success in getting rid of the sourish smell from the right ear of this 15-year-old Jack Russell. Ear smear showed cocci bacteria.  I had the ear irrigated and prescribed antibiotics and ear ointment 3 x per week.  

Thursday, July 21, 2016

2980. The cat had a tibial fracture 9 months ago and now walks almost normally after pinning at Toa Payoh Vets

July 21, 2016
The woman in her 50s feed 24 stray cats every evening all by herself.

"Cat food prices keep going up," she spent around $700 per month to feed 24 cats.

She brought this cat to me for fixing the fractured leg hind leg 9 months ago, being referred by her vet in Tampines.

An intramedullary pin was put in and the two bone pieces were aligned. I told her to return 6 weeks later to get the pin removed from the left hind leg. She did not come.

On Jul 2016, it was 9 months later. She phoned me as to whether the pin ought to be removed now and to bring the cat to see me.

She texted and sent the above-mentioned video:

"Princess had a left tibial fracture of distal 1/3 in the left hind leg 9 months ago fixed by you. The left hind leg sticks out when she is in the sitting position. Stilted gait.  Does Princess need to take out d pins? She can jump n run (a little award). U can tell her gait is not normal unlike other cats. Don't think she is suffering."

Being over 50s, she had never WhatsApp videos. To save her time and money as she is stressed out with cat feeding after work, I asked her to WhatsApp the above video. The cat looks OK and is normal in daily life.

So, I replied: Wait till there is a problem like lameness or loss of appetite. Take care of your health."

She texted: "OK".

Feeding 24 cats every night till midnight without fail and cleaning the area is a considerable task for this working woman. Dry cat food prices and the cost of living has shot up again.

Nobody wanted to help her. She had a young lady who helped out a bit but now she has shifted house far away.

If she had a younger dedicated person to help her set up a blog to update and showcase her good work and provide proper accounting, I am sure she can get some of the monthly  $700 in donations for the cat food from cat lovers.

For my part, I provided a listening year and this message:

Any kind soul willing to help her take care of the 24 stray cats or financially support part of the cat food purchase, please tel +65 9760 8313, Mdm Chua. 

Tuesday, July 19, 2016

2979. A young couple's terrapin gasps for breath 4 days ago

July 19, 2016

This terrapin with dark green pretty squarish patterned hard shell gasped for breath 4 days ago and was hospitalised. by me. The other two in the same tank (video) were normal and did not suffer from respiratory infection. 

"It could be due to smoking by family members," Dr Daniel said.
The couple were smoking outside the surgery but they confessed they never did it in front of the tank.
"My brother did smoke near the terrapins," the husband recalled This terrapin could have inhaled the smoke and got respiratory infection or irritation.

"It is amazing that the other two terrapins are not affected," I said. After 4 days of treatment at Toa Payoh Vets, the terrapin ate and recovered. No longer open-mouthed.  

I advised no live fishes in case of parasites and removal of the small stones in the aquarium.
The terrapin no longer gasps for breath (see video) but he has to live separately from the others for one month and given antibiotics for another 7 days.

The aquarium tank is well decorated and it is a pleasure to see the 3 terrapins swimming vigorously inside the tank. The couple had changed the filters and got rid of the smaller stones. As you can see in the video, the terrapin no longer gasps. 

2978. A 10-year-old Jack Russell has large breast tumours

July 19, 2016

Jack Russell, F, 10 years
I had seen this dog as a puppy and was surprised to see her after so many years.
"Her breast tumours grow very fast in the last 2 months," the owner said.
The largest tumour was the size of an orange, measuring 13 cm x 13cm x 10 cm. on the right MG 4 & 5 glands. The left MG1 and 2  and the left MG4 and 5 had large hard tumours too..

X-rays and blood test taken. 
There appeared to be lung nodules.
"The breast tumours are likely cancerous," I said. "They will recur after surgery, sometimes as early as within 3 months."

Removal of the large right breast tumour and spaying the dog would be the first step, if possible. 3 weeks later, removal of the left MG1 and 2 and MG 4 and 5 tumours.. There will be insufficient skin to stitch up.