Tuesday, October 29, 2013

1138. Follow up on the 14-year-old Maltese with "7 days to live".

Yesterday Oct 29, 2013, I was much surprised to find this Maltese still alive when I predicted "7 days to live" one month ago. The Maltese had great difficulty breathing and her abdomen was tense and swollen. There was this large orange-sized tumour in the front half of the abdomen and a balloon-like swelling of the abdomen. 

The young lady owner had come to me after Vet 1 had diagnosed a massive anterior abdominal tumour and the blood test had shown anaemia. She had recommended some pain killers and gave a poor prognosis. Her diagnosis was spot on as regards this massive tumour. It could be a spleen or liver tumour. However the liver enzymes in the blood test were normal. My prognosis of "7 days to live" was also grim. After treatment and drainage of the 20 ml of fresh blood from the abdomen, an iron injection and giving drips and heart disease medication, the dog went home.

Yet 30 days later, this old Maltese was alive. She no longer panted as she was on heart medication. "She would not eat by herself for the last 2 days," the young lady who came with her mother and brother said. "The gums are pink.The heart and lungs are OK.," I said after examination. "There is no abdominal swelling. The abdominal lump is as firm and as large as an orange and this may press onto the diaphragm, stomach and chest causing pain. Yet this Maltese did not feel any pain when I palpated the abdomen.The left kidney was enlarged to around 3 cm x 3 cm and there was no fluid at all. "The rectal temperature at 37.2 C is low," I said.

Under gas anaesthesia, I used a fine needle to aspirate 0.5 ml of blood from the edge of the tumour. After the drip and medication, the dog started to bark and was more active.

In this case, I did check on the IV drip which had stopped flowing for some reasons. Dr Daniel had inserted the IV catheter well with sticky elastoplast as there was still blood flowing out when he took out the blue bandage wrapping the tubing. My assistant had flushed saline to clear the blockage 3 times but I could still see blood at the one end of the catheter indicating there was no IV drip flow.
After checking, the IV drip flowed and so the dog had his glucose and salts and hence was feeling well to bark.

Surprisingly the body weight was 3.4 kg, about 0.1 kg more than 30 days ago. I advised the lady owner to hand feed the food as well as the medication and prescribed pain-killers this time. I got a blood test done. To save money for the family, I did not ask for another X-ray or ultrasound. The mother was surprised that the dog had a large abdominal tumour the size of an orange when I spoke to her as well. The daughter had not told her. 

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