Tuesday, December 9, 2014

1130. Threshold of death. A 14-year-old Maltipoo cannot breathe - a gigantic right submandibular abscess

2nd case within 2 weeks of a large submandibular swelling in the dog.
The other dog with similar swelling on the submandibular had no pain and a cytology revealed cyst.
In this 14-year-old male maltipoo, he was not eating for one day. Panting and breathless.
Bad breath. Drooling on right side of cheek. Large swelling  6" x 3" extending below neck. Very painful.T=39.4C. What's wrong?












X-ray of this maltipoo on first consultation on Dec 9, 2014












BLOOD TEST
Dec 9, 2014

Abnormal
Total white cell count 68.5 (6-17)
 N 98%  (60-70%)       N absolute 67.13  (3-11)
L  1.6%    L Absolute 1.10
M 0.1%  Absolute 0.07
E  0.3%   Absolute 0.21
B  0%

Platelets  142  (200-500). 
Several abnormal lecuocytes seen. Occasional nucleated red blood cells seen. Large platelets present. 

HISTOLOGY report from 2 biopsy punches on side of submandibular swelling.
No malignancy

URINE TEST
pH 6.5 SG 1.030. Protein 2+. Blood trace. Bacteria 3+.  White blood cells 288. Red blood cells 18. Epithelial cells 38.   Suspect UTI


During the IV drip on Dec 9, 2014, the dog with breathing difficulty started barking in response to another Spitz barking. Suddenly he collapsed with cyantoic tongue. This was surprising. I quickly punched his chest on the spot and massage vigorously, to stimulate the heart beat. I pulled his tongue out with forceps so that he could breathe. There was no time to waste as he was in the throes of death.

Fortunately he recovered and the owner was happy to see him alive. He went home in the evening with medication.

FOLLOW UP
on Dec 10, 2014, 10 am, I phoned the owner to discuss the blood test report and the possibility of a severe bacterial infection of the throat area.

"The dog is breathing better than yesterday," the wife said.."He eats a little egg yolk and meat and drinks water by himself."

"Any stools passed?" I asked.
"No."

I got another blood test done on Dec 15, 2014 

BLOOD TEST
Dec 15, 2014

Abnormal
Total white cell count 45.1 (6-17)
N 86%  (60-70%)       N absolute 39  (3-11)
L  9%    L Absolute 4.1
M 5%  Absolute 2.3
E  0%   Absolute 0
B  0%

Platelets  135  (200-500). 
No platelet clumps seen.

Liver disorder this 2nd test. Hepatitis.
SGPT/ALT  424  (below 59) SGOT/AST  106  (below 81)


FOLLOW UP on Dec 19, 2014 9.47 am

Dog is active, not breathless.  Eat, drinks and pees a lot. Advised resting, no serious exercise

FOLLOW UP ON JAN 5, 2015 at 3.45 pm

I first saw the breathlessness and painful right submandibular swelling, measuring 6" X 3" on Dec 9, 2014. Today is nearly one month later. The dog came in for a check up.  No more swelling at all. 

All are well with his appetite and drinking, peeing and pooping. He has the occasional coughing after eating. I advised dental scaling today, as the bad breath would return after all these antibiotic mediation.

The ears are no longer infected as the ear drop medication was applied. The dog actually put on weight and today, is 10.1 kg compared to 9.7 kg on Dec 9, 2014. 


CONCLUSION
The bacteria would be from the chronic ear infection of the past  6 months. The owner went to a vet who prescribed medication but the pus kept coming out from the ear. The owner did not seek further treatment. Then the dog became inactive and the next day, developed a right submandibular swelling. He could not breathe normally. The owners decided to come to Toa Payoh Vets.

This case is most likely a bacteria infection from the vertical canal going into the side of the ear and downwards. This bacteria was very fast growing and the 14-year-old dog's immune system could not fight it. Neutrophils went up to 98% (normally 60-70%) and the total white cell count shot up sky high.

I searched google and there is a similar submandibular swelling from a chronic ear abscess in another country. Another vet had operated but the pus persisted. Foreign body or tumour was suspected to be the cause of this pus which kept coming out of the ear as in my case. The bacteria cultured was psuedomonas. The case is at:
https://www.youtube.com/watch?v=OtjgriWDqCE

TIP.  The owner should not let ear infections esp. with pus linger on for months without seeking a second opinion from another vet.

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