Monday, January 3, 2011

288. Jan 3, 2011 interesting cases

Jan 3, 2011

My car's dashboard showed "check coolant level" again after repair last month. The mechanic had replaced the pump and had said the radiator was OK. It was a poor diagnosis as now the problem re-surfaced. I had to send the car down again. It was a radiator leak.

On the way, I visited my mentor, a senior vet to wish him a Happy New Year. "Where's XXX?" he asked about the 4th year vet student who was supposed to do internship. "He's got to re-sit his exam and has to study." I said. I asked about his son who had started an ice-cream production using artificial sweetener. He was already producing the ice-cream. The nurse brought in two cones in the vet's office where a fish tank of ordinary small golden fishes were kept (to give life to the office, the father said). "How's the ice-cream?" the son asked me later. "Too sweet," I said. "That's strange. The others said it was not sweet." I said: "Not as sweet as The Magnum ice-cream but I prefer less sweet so as not to over-work my pancreas and get diabetes at my age." He asked: "Take a tub back to the vet office." I declined as I did not have a big fridge there. I advised him to accept investors and not worry about "dilution of the brand." I said: "Cash flow is important. If investors provide the cash flow, you can invest in better equipment and retail stores." At the moment, he is selling it online.

INTERESTING CASES
Case 1. The 12-year-old Silkie with two firm and enlarge testicles.
"You removed his kidney stones 5 years ago," the young couple said. "It cost us $600." I looked at the 2007 records and yes I did the surgery for $300. "Any difficulty in peeing?" I asked. "No more. Sometimes we see blood in the urine."

4 weeks ago, Vet 1 had treated the dog for fever. 2 weeks ago, Vet 1 gave some medication for the testicular problem but the size of the two testicles did not reduce. They were 3x the normal size. "Did Ve1 1 propose surgery?" I asked. The couple went to Vet 1 as it was nearer to their place but had wanted me to operate in 2007 as I was cheaper. "I think so," the young man said. I scheduled the dog for surgery the next day. "No other way to cure" I said. "Likely to be testicular tumours or cancer. You need to pay for histopathology lab to check out."

"What if I don't want the lab test?" the young man asked. "It is a personal decision," I said. "What advantages in having a lab test?" he asked. "If the growth is not cancerous, the dog will live to its normal life." I said. "If cancerous, medication may be needed."

"There are only 3 types of testicular cancer in the dog," the young man said.
"No, there are more but 3 main types," I said. "Only a histopathology will tell. In your dog, he is very old. You may not see him alive again if his heart fails during anaesthesia," I warned the couple. "I will try to shorten the surgery. I still need to cut off the whole black scrotum instead of just taking out the testicles. It will take some time to stitch."
The young man asked: "Why?"
I said: "Just in case there is cancer and the scrotum, if not removed, still harbours the cancerous cells."
I hope all will be well during the anaesthesia.
Blood and urine tests are done. "It costs $600 like last time," the young man said. "You are fortunate that your dog costs you so little over the last 12 years as he needed only a bladder stone surgery," I replied. "For some owners, they spend thousands of dollars for treatment of their sick dog. The $600 include histopathology, blood and urine tests which should be done." I did not include consultation fees for this couple. It was a joy to see the dog again. I do recognise him now as he has that golden hair in his head.

I was thinking sadly of the 12-year old Schnauzer Cross admitted yesterday Sunday due to fits and recumbency. He died at 4 a.m today. His owner had spent some money trying to prolong his life and would be getting TCM (Traditional Chinese Medicine) from Vet 1 today, Monday. He had chronic kidney failure and was gasping and recumbent and had fits and was hospitalised. He vomited food and died around 4 am. "How do you know it was 4 am?" the owner asked when he came at 11 am to make cremation arrangements. "My staff was on duty," I said.

Case 2. As regards a dog in recumbency (unable to sit or stand up), an older man and a gentleman friend brought in his Mini-Bull Terrier with pus in the eyes and flat out. His dog was OK and was boarded at a friend's place. Such old dogs are seldom vaccinated. "Very high fever" I said. "Was he boarded in a dog kennel?" I asked. "No," he said. "A laundry." I took the blood test, gave the dog IV drip, anti-fever and anti-antibiotics. The fever went down and the dog sat up and looked around at around 6 p.m. I was glad he was OK for the time being. As to the cause of his very high fever, it is hard to tell.

Case 3. The 15-year-old Beagle with a painful mouth.
A couple in their late 50s asked: "Is it possible just to give antibiotics every time the dog has painful mouth instead of anaesthesia and extraction? We don't want the dog to die on the operating table!"

"Antibiotics will not work over time," I replied. "They will not be effective. The bacteria will spread all over the dog's body. As he gets much older, his immune system will not cope. He will die of toxaemia and bacterial infections." Sounds dramatic? The husband showed me his iPhone picture of the dog's teeth. They were clear pictures and showed tartar and red ulcers at the gum level. He lifted the dog's side and showed me the real gum and teeth.

"You are aware of the high risk of anaesthesia in dogs over 8 years of age," I advised. "This dog is 16 years old." I checked the heart. He did not have serious heart murmurs. "There is one swelling below his right eye and a smaller one in his left," the husband pointed the lumps to me. "Yes," I said. "They will be the starting of the carnaissal tooth abscess. The bacteria from the root of the teeth had punctured the facial bone and abscess will pop out below the face some time later. It is also called an oro-nasal fistula." I took out the Hills' Anatomy book and showed the picture of the carnaissal tooth abscess.

Anaesthesia and dental work would be done tomorrow. It would be very high risk and the owners had expected a good outcome.

Case 4. Pyometra? A very thin Shih Tzu female around 1 year old had been vomiting for the past 6 days. "What's the cause?" the owner asked. There were no diarrhoea or abdominal pain or swelling or fever. The owner did not want blood test. This was difficult. The only finding was that the vulval area was inflamed and wet. "When was the dog on heat?" I asked. "Some 4 weeks ago." he said. So, the probable diagnosis was open pyometra. I put the dog on IV drip and antibiotics and kept her for 2 days. Owners don't like longer hospitalisation.

Case 5. Luxated lens. The father did hit the dog on the head 2 weeks ago. The dog had been rubbing his left eyelid area and it was red. "Is it glaucoma?" the owner asked me yesterday and pointed to a black spot in the upper eyelid. I examined the dog properly under general anaesthesia (domitor and isoflurane). There was a slight increase in intro-ocular pressure in the left eye. The main problem was that the lens had luxated into the anterior chamber, causing pain and eye rubbing. Surgery was advised. Much depends on the owner.

Case 6. 12-year-old dog with teeth extracted.
The young man and his father brought the old dog for dental extraction (periodontitis Grade 4 - the worst of the disease) and was boarded yesterday. They bargained hard. "$400 is the lowest rate for everything including hospitalisation, IV drips and antibiotics, anaesthesia and surgery," I said. The dog survived the anaesthesia. The 10 rotten teeth were kept but my man did not show him at first. He phoned me as I was off work. "I pay $400 just for some dental work and one day stay," he said over the phone in an "taken for the ride" tone of voice. This is the type of calculating client I dislike a lot. This is not the way to conduct business.

I said: "The fees have been agreed. I cap it at $400 for you so that you know the costs. It should be much more. I charge $20/tooth extracted." I asked my assistant to get the teeth out to show him. It is best to attach all evidence next time. Later he text messaged me to apologise. I text back "Thanks." All vets get all types of personalities a day and some of them can be abusive to staff.

As you can see, there is a variety of conditions encountered today, even in one species, the canine. No cats or hamsters came today.

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