Case 1. The Shih Tzu has back ache
"I was told to come at 9 am if I want to consult you," the lady with a Shih Tzu was waiting on this fine Vesak Day. I do morning consultations and surgeries daily except Saturdays and usually I require appointments to be made.
It was 70 days ago and I was surprised to see the owner's mother. The owner was actually the daughter who is studying overseas and was diligently ensuring that her mother take good care of this old Shih Tzu. I guess the daughter grew up with this dog and loved her very much.
I took out the case card and there was a note saying that I had phoned the owner's mother to come to collect the medication for the dog with back ache problems. The dog was hunched and could not stand on her hind legs 70 days ago. I had given medication and injection and advised strict cage confinement for at least 3 months. Also, a follow up one month after the injury to the back.
"Why didn't you come to pick up the medicine to bring down inflammation for the dog for another 4 weeks?" I asked as Mr Min took out the bag of medicine from the cabinet. I checked the T/L spinal area by pressure using my forefinger and middle finger to press directly and firmly from the neck to the tail. At the spinal area around vertebra T10 to L3, the dog reacted with a soft "ha" and did so when I repeated the palpation. It was a quiet "cough" but the mother confirmed she could hear it. There was no painful whimpering on spinal palpation now. When I placed the dog's hind legs onto the edge of the table, the dog could not put her hind feet forward instantly. I showed the owner that the dog could do so with the front feet. So, the placing reflex was still absent in this dog and she has not fully recovered.
"I have put the dog inside the cage for the last 2 and a half months," the mother said. "She would like to run all over the apartment like a bullet train but I did not allow her to do so."
"The news is good," I said. "Strict cage confinement for the last 2 and a half months helps the injured disc area to heal." I did not dwell more on her missing out on the NSAID medication as she had already said she was busy working. I decide that I must implement a system of putting such reminder info on a notice board so as to give a second reminder in the interest of the dog.
"I have been busy working," the mum said. "What are the two lumps on the dog's back?"
"The two cauliflower lumps are warts," I said. "Older dogs do get warts and the cause is said to be a virus."
"What is your advice?" the mother asked me whether a 3rd small swelling nearer to the tail was the 3rd wart.
"I will advise clipping of the coat and see how many warts there are. Get all warts excised when they are small. Nobody knows exactly why warts appear. Warts appear in very young and old dogs. I had a case where the dog had over 50 warts because the vet advised that there was no need to do anything. The warts got infected and bleed and so I had removed all of them. Some do return but most had gone in this old dog."
Spinal disc injury cases need monthly follow-up by the owner for the first 3 months. Unfortunately many don't if they see the dog as improving.
There is a grey line crossed if vets phone up the owner to get the follow up done as the owner may ignore or mis-construe that the vet is soliciting for business.
CASE 2. The Miniature Schnauzer can stand up only when given steroids.
Recently, my specialist in the Singapore General Hospital phoned me about his friend's dog, a 9-year-old Miniature Schnauzer who could stand up and walk if he takes the steroidal drugs. Without the drug, the Schnauzer could not stand up.
The doctor said: "The Schnauzer could have 'mini-strokes' earlier as his head tilted to one side. Vet 1 gave the steroids and the dog improved. Then he could not get up to walk on his hind legs and Vet 1 gave steroids. The dog could walk only when he takes the drugs. What is your diagnosis?"
"Didn't Vet 1 provide the diagnosis?" I asked.
"She said there was nothing wrong with the dog," the specialist said.
I found this hard to believe and advised him to get the medical records as Vet 1 is an experienced battle-hardened vet. The dog owner was very distressed and so the specialist phoned me for a short consultation out of the blue.
"Is there any cure if the dog has spinal disc injury?" he asked.
"There is the surgical treatment," I said. "But in most cases, there is no permanent cure and the surgical treatment needs to be expertly done by an experienced vet."
I advised tapering off the steroid and stopping all steroids if the specialist's friend wanted me to examine the dog. Pain-killers mask pain and therefore there was no point in being consulted as I would not be able to locate the injured spinal area by palpation. X-rays may help. In any case, a telephone diagnosis is very risky and unprofessional and I tried not to give any diagnosis as things don't appear to be what they are on the ground as compared to telephone imaginations and conversations.
P.S. Dogs with head tilted to the side would appear to suffer from "mini-strokes" to the human medicine doctors as they equate hemi-paralysis of the face and body with strokes or mini-strokes. In dogs, the most common cause would be otitis media!