Friday, August 21, 2015

2971. INTERN Time is running out - case 1. An 11-year-old Jack Russell has false pregnancy and 4 breast tumours

Aug 21, 2015

TIME LINE

10 years ago, I advised spay 2 months after the end of the heat bleeding. The owner did not turn up.

5 years ago, the owner noticed a small breast lump in the dog. His son told him to seek veterinary attention. He did not want the dog to suffer post-op pain. The dog had surgery to remove a pebble in the intestines by another vet and his wife had to take leave to care for her. So no more operations.



TODAY  Aug 21, 2015
The dog was not eating much. I examined her and found 4 breast lumps (video). I expressed some milk from one of the breasts. There was no vaginal discharge now. So, false pregnancy and/or pyometra is diagnosed. The hormonal changes of false pregnancy would affect the dog's appetite and behaviour.

"Did she carry a soft toy or blanket to a corner and was protective of it?" I asked. "As if she had a newborn puppy?"

"Yes," the owner said. "She carried a towel and went to a corner. What do you advise about the breast tumours? Do you advise euthanasia?"

"The decision for euthanasia is up to the owner," I said. "This dog is still active. She needs spay and breast tumour removal but at her age of 11 years old, you may want to think about her few remaining years, the medical costs and the post-op pain. Generally, most dogs do not suffer from post-op pain as they are given pain-killers."

The owner will decide with his wife.

Blood test, X-rays of the lungs, spay and breast tumour removal, high anaesthetic risks and post-operation complications and pain.  Whether it is worth doing the operation as the dog is near the end of the life span. These must be considered.

Aug 25, 2015
Blood test showed high cholesterol and very high liver enzymes.

"This dog cannot be spayed now as the risk of anaesthetic death is very high," I said. Five years ago, the dog had a single breast tumour but the owner chose to ignore this growing tumour. He said that his wife had to take leave to take care of this dog after a pebble was removed from the intestine. So, he did not want the dog to suffer post-operation pain again, if she had her breast tumour surgery.

Time is  running out now as the dog now has 4 growing and big breast tumours, 3 on the left side and 1 on the right side. Their sizes were more than 5 cm across. No biopsy was done to lower medical cost.  So, it was not possible to state that these tumours were malignant or not. I had advised a spay to remove the ovaries which produce hormones encouraging breast tumour growth in some cases.  Not every case as you can see in the case of the Pekinese that did not develop breast tumour after tumour removal and without the owner spaying her as advised.

"My dog recovered her energy and appetite after consulting you," the man said. On superficial appearance, the dog is normal, with good food like roasted pork pieces being fed when she had lost appetite a few days ago. A high cholesterol level and liver disorder now presented itself.

"My son noticed her elbows and her sternal area were yellowish," the man said.
"He is very observant young man," I told him I had noticed a yellowish strip of sternal skin on that day but had not pointed this to him. "I thought he had stained himself but this yellowish skin do look like jaundiced skin."

As the eye white was not yellowish, I ignored this finding and did not tell the owner. Usually jaundice presents itself as yellowish eye white. Now, the blood test had shown that this dog has a severe liver disease. The total white cell count was normal, but the neutrophils were higher. This could be a start of bacterial infection and my antibiotic medication had eliminated the bacteria based on the dog's rapid recovery of appetite.

"What can be done now?" the owner asked. Dr Daniel had advised him on a prescription liver diet for the next 1-2 weeks and he had come for the canned food. Unless the dog's health deteriorate, this would be the course of action. I agreed with him.

Time is running out for this dog. There is no point saying that she should have been spayed 5 years ago when she had only one breast tumour as in the case of the Pekinese with foul-smelling vaginal discharge.      

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