This terrapin has loose flabs of skin in the thigh area and looks very pale compared to normal terrapins. The owner had confined him to a small plastic tank and he had stopped eating for some months. Antibiotics, tank hygiene, sunshine and a much bigger tank are advised.
Video
Wednesday, August 26, 2015
2972. INTERN. Time is running out - Case 2. A female Pekinese passes foul-smelling vaginal discharge
August 25, 2015
Two years ago, I had this female Pekinese's breast tumour removed and advised spaying the dog as some breast tumours are more likely to develop in dogs not spayed. The dog's teeth were enveloped in thick tartar and I advised dental work to get rid of the bacteria inside the tartar. The lady owner did not accept my advices.
Today, the dog came with a dark brown vaginal discharge. The rotten meat smell of the discharge filled the consultation room. "I know she is suffering from uterine infections," the lady said. "I have researched the internet." The dog had a prominent spine, indicating a loss of weight but she did not have other breast tumours developed in the past two years.
Now a life-threatening condition of pyometra. This was one of the worst cases of open pyometra based on the bad odour and copious brownish vaginal discharge.
"The treatment is spay but she is so thin and will likely die under anaethesia," I prescribed oral antibiotics and gave an injection of antibiotics."So I will not advise surgery to remove the badly infected womb. She may die in the next few days despite antibiotics as she is not eating."
This Pekinese who strongly resisted swallowing the antibiotic capsule I gave to her through the mouth. She snapped at my fingers. I had put her on the consultation table. I decided to grasp the capsule with a pair of forceps and inserted the capsule into her snapping mouth, far back in the tongue and closed her mouth. She swallowed one capsule and there would be 13 more, at twice a day. The owner would have to hand feed her and give her water to drink.
Time is running out for this Pekinese. If the owner had at least spayed her 2 years ago, this dog would not have pyometra and causes so much emotional distress for the owner and the vet. Time has run out for this Pekinese as death from sepsis could be imminent. No blood test was taken to lower medical costs. This type of against medical advice to spay a dog after removal of a breast tumour is quite a common occurrence.
Pyometra that could have been avoided by a spay operation after breast tumour removal makes me feel sad for this Pekinese. She had lost a lot of weight but could still fight to avoid oral medication. If she is stable after 7 days, she could be spayed. But her emaciated body may not take anaesthesia well and she may die on the operating table. The stench of rotting uterine lining is an indicator that spaying cannot be delayed. Many owners will not accept their dog dying on the operating table and will blame the vet. So, it is best for the vet not to undertake such high risk surgeries.
Two years ago, I had this female Pekinese's breast tumour removed and advised spaying the dog as some breast tumours are more likely to develop in dogs not spayed. The dog's teeth were enveloped in thick tartar and I advised dental work to get rid of the bacteria inside the tartar. The lady owner did not accept my advices.
Today, the dog came with a dark brown vaginal discharge. The rotten meat smell of the discharge filled the consultation room. "I know she is suffering from uterine infections," the lady said. "I have researched the internet." The dog had a prominent spine, indicating a loss of weight but she did not have other breast tumours developed in the past two years.
Now a life-threatening condition of pyometra. This was one of the worst cases of open pyometra based on the bad odour and copious brownish vaginal discharge.
"The treatment is spay but she is so thin and will likely die under anaethesia," I prescribed oral antibiotics and gave an injection of antibiotics."So I will not advise surgery to remove the badly infected womb. She may die in the next few days despite antibiotics as she is not eating."
This Pekinese who strongly resisted swallowing the antibiotic capsule I gave to her through the mouth. She snapped at my fingers. I had put her on the consultation table. I decided to grasp the capsule with a pair of forceps and inserted the capsule into her snapping mouth, far back in the tongue and closed her mouth. She swallowed one capsule and there would be 13 more, at twice a day. The owner would have to hand feed her and give her water to drink.
Time is running out for this Pekinese. If the owner had at least spayed her 2 years ago, this dog would not have pyometra and causes so much emotional distress for the owner and the vet. Time has run out for this Pekinese as death from sepsis could be imminent. No blood test was taken to lower medical costs. This type of against medical advice to spay a dog after removal of a breast tumour is quite a common occurrence.
Pyometra that could have been avoided by a spay operation after breast tumour removal makes me feel sad for this Pekinese. She had lost a lot of weight but could still fight to avoid oral medication. If she is stable after 7 days, she could be spayed. But her emaciated body may not take anaesthesia well and she may die on the operating table. The stench of rotting uterine lining is an indicator that spaying cannot be delayed. Many owners will not accept their dog dying on the operating table and will blame the vet. So, it is best for the vet not to undertake such high risk surgeries.
Saturday, August 22, 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.
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.
Tuesday, August 18, 2015
2970. A 10-year-old Chihuahua sleeps curled up
Aug 13, 205
Suddenly the 10-year-old female spayed Chihuahua slept curled on the right side worrying the owners. Much loved by the couple, esp. the wife. Weight was 2.6 kg, looking rather plump. Has an excellent appetite.
I palpated pain behind the right side of the rib cage, around the right kidney.
X-rays
right 9th rib appeared fractured.
multiple lung nodules, liver enlarged? spleen OK.
Were the liver and spleen enlarged?
Blood test
Only the kidney profile is not normal
urea 3.5 (4.2-6.3)
creatinine 63 (89-177).
Platelets 578 (200-500)
Treatment was painkiller rimadyl for 4 days and antibiotics.
AUG 18, 2015
Follow up by tel. The dog sleeps in the usual sternal position since treatment and the husband was most happy. No more curled up in the foetal position when sleeping. He enquired about the W/D diet to reduce the weight. No jumping up and down.
Suddenly the 10-year-old female spayed Chihuahua slept curled on the right side worrying the owners. Much loved by the couple, esp. the wife. Weight was 2.6 kg, looking rather plump. Has an excellent appetite.
I palpated pain behind the right side of the rib cage, around the right kidney.
X-rays
right 9th rib appeared fractured.
multiple lung nodules, liver enlarged? spleen OK.
Were the liver and spleen enlarged?
Blood test
Only the kidney profile is not normal
urea 3.5 (4.2-6.3)
creatinine 63 (89-177).
Platelets 578 (200-500)
Treatment was painkiller rimadyl for 4 days and antibiotics.
AUG 18, 2015
Follow up by tel. The dog sleeps in the usual sternal position since treatment and the husband was most happy. No more curled up in the foetal position when sleeping. He enquired about the W/D diet to reduce the weight. No jumping up and down.
2969. INTERN The 7-year-old Silkie passes strong smelly urine
Saturday, August 15, 2015
An unusual feast of cases this Saturday morning and morning at Toa Payoh Vets.
Outstanding cases include:
A 7-year-old female Silkie X passes very smelly urine, blood and pus for many times and had been treated by vets. The lady had consulted 3 vets in a practice but the dog passes smelly urine after a course of antibiotics. Blood tests and X-rays were done.
So, she brought the urine sample in a bottle to consult me for a 2nd opinion. The ammonia smell was overpowering.
"Was urine test done?" I asked.
I palpated a "fish ball " sized bladder. It could be a thick-walled bladder which had been inflamed for many months or there could be bladder tumours and small stones.There was pain in the kidney area (video).
I got a urine test done.
pH 9, SG 1.03, Nitrite +, protein 4+, blood trace, bacteria nil, crystals triple phosphate +, amorphous phosphate 3+.
There was no bacteria as the owner had given a course of antibiotics from the other vet.
Blood test
Kidneys were OK. No abnormal blood cell count or numbers.
Treatment
IV drip with antibiotics and painkiller. Trimax tablets at 1/4 twice per day for 14 days.
Follow up on Aug 18, 2015
No smelly urine as the dog was on trimax.
The dog is advised to go on C/D
Ultrasound advised to check for bladder tumours
X-rays from the other vet needed although the vets said no stones.
A blood test 2 months later.
Advised spay as the vulval area and ventral skin area in the groin were hyperpigmented black since the dog had been licking it for many years. Possibly the dog had open pyometra leading to licking and bacteria entering the bladder causing infection. I explained to the lady that in female dogs, the urethral opening can be easily infected from the pus passed out from the uterus.
"I do not want my dog to suffer from pain (involving spay surgery)", the lady said. So this advice that could save the dog's life in later years was given but not accepted. Pyometra could worsen leading to septicaemia and death 2 years later.
An unusual feast of cases this Saturday morning and morning at Toa Payoh Vets.
Outstanding cases include:
A 7-year-old female Silkie X passes very smelly urine, blood and pus for many times and had been treated by vets. The lady had consulted 3 vets in a practice but the dog passes smelly urine after a course of antibiotics. Blood tests and X-rays were done.
So, she brought the urine sample in a bottle to consult me for a 2nd opinion. The ammonia smell was overpowering.
"Was urine test done?" I asked.
I palpated a "fish ball " sized bladder. It could be a thick-walled bladder which had been inflamed for many months or there could be bladder tumours and small stones.There was pain in the kidney area (video).
I got a urine test done.
pH 9, SG 1.03, Nitrite +, protein 4+, blood trace, bacteria nil, crystals triple phosphate +, amorphous phosphate 3+.
There was no bacteria as the owner had given a course of antibiotics from the other vet.
Blood test
Kidneys were OK. No abnormal blood cell count or numbers.
Treatment
IV drip with antibiotics and painkiller. Trimax tablets at 1/4 twice per day for 14 days.
Follow up on Aug 18, 2015
No smelly urine as the dog was on trimax.
The dog is advised to go on C/D
Ultrasound advised to check for bladder tumours
X-rays from the other vet needed although the vets said no stones.
A blood test 2 months later.
Advised spay as the vulval area and ventral skin area in the groin were hyperpigmented black since the dog had been licking it for many years. Possibly the dog had open pyometra leading to licking and bacteria entering the bladder causing infection. I explained to the lady that in female dogs, the urethral opening can be easily infected from the pus passed out from the uterus.
"I do not want my dog to suffer from pain (involving spay surgery)", the lady said. So this advice that could save the dog's life in later years was given but not accepted. Pyometra could worsen leading to septicaemia and death 2 years later.
2968. A 9-year-old not spayed Maltese became comatose
Aug 18, 2015
This morning, I went to the pet shop to buy hamster food. The aunty at the pet shop asked what caused her niece's Maltese to die? She had not asked the niece who was grieving over the death.
I told her that the Maltese was comatose and had fits when her niece brought the dog into my clinic 3 days ago. The dog had septicaemia as the total white cell count was 70 (5-17 being normal) and the neutrophil % was 98% (60-70% being normal). There was insufficient blood glucose.
The dog was recumbent and despite IV drip and glucose, the dog died after 2 days of in-patient. She was in heat 3-4 weeks ago and I suspected pyometra.
Brownish red blood oozed out from the vagina after she died and the niece saw it. The parents and the pre-teen children came to visit the dog. The niece got a man to cremate her.
This death could have been prevented by early treatment or by spaying the dog at 6 months of age. This dog would have lived much longer as her kidneys and liver were normal as shown in the blood test. Her teeth was encrusted with tons of tartar but the niece ignored my earlier advice to get dental work done.
Bacteria could have reached the blood stream via the mouth or infected uterus. It is hard to say where the bacteria in the blood originated.
I did not want to bring out this sad topic with the aunty as this was death that could have been prevented by spaying.
This morning, I went to the pet shop to buy hamster food. The aunty at the pet shop asked what caused her niece's Maltese to die? She had not asked the niece who was grieving over the death.
I told her that the Maltese was comatose and had fits when her niece brought the dog into my clinic 3 days ago. The dog had septicaemia as the total white cell count was 70 (5-17 being normal) and the neutrophil % was 98% (60-70% being normal). There was insufficient blood glucose.
The dog was recumbent and despite IV drip and glucose, the dog died after 2 days of in-patient. She was in heat 3-4 weeks ago and I suspected pyometra.
Brownish red blood oozed out from the vagina after she died and the niece saw it. The parents and the pre-teen children came to visit the dog. The niece got a man to cremate her.
This death could have been prevented by early treatment or by spaying the dog at 6 months of age. This dog would have lived much longer as her kidneys and liver were normal as shown in the blood test. Her teeth was encrusted with tons of tartar but the niece ignored my earlier advice to get dental work done.
Bacteria could have reached the blood stream via the mouth or infected uterus. It is hard to say where the bacteria in the blood originated.
I did not want to bring out this sad topic with the aunty as this was death that could have been prevented by spaying.
Monday, August 17, 2015
2967. INTERN. A cat has dysuria and pollakiuria after boarding
Aug 17, 2015
Aug 15, 2015. Cat. 4 years. Female. Boarded last week. Dysuria and pollakiuria for the past 5 days.
Black and white cat. (video).
AUGUST 15, 2015
On August 15, 2015, I saw this 3-year-old male, not neutered cat. He peed with difficulty (dysuria) and dribbled urine all over the apartment (pollakiuria) for the last 5 days.
AUGUST 5-10, 2015
He was in a boarding cattery in Pasir Ris ing for 5 days over the National Day holidays (Aug 5-10). The owners were worried about his illness.
"Are there other cats in the house?" I asked.
"No," the wife said. So this cat would not be stressed out by sharing litter boxes or bullied by other cats. As for toilet, he goes to the squatting toilet bowl to do his business.
AUGUST 15, 2015
I palpated the kidneys. The cat reacted in pain (Video clip). X-rays showed enlarged kidneys (image).
The blood was collected from the jugular vein (video clip). Blood results showed normal kidneys and liver. Only that the platelet count was low at 33 (300-800). The low platelet count could mean that this cat had licked some poisons during boarding. The owners said that the cat's body had a strong stench of urine and smell on return from boarding. These body stains would be toxic and the cat would attempt to groom himself, licking off as much of the toxic contaminants on his body. The toxins entered his blood stream. They caused pain in the bladder and urination.
Treatment was by haemodialysis with IV drip to flush out the toxins in the blood. Antibiotics and painkillers. The cat was boarded for one day and went home on August 16, 2015.
AUGUST 18, 2015 TEL TO OWNER.
As at Aug 18, 2015, the cat is active and has recovered fully his bladder control.
ADVICES TO OWNER
1. Lifestyle of the cat is as follows:
1.1 Daytime - free to roam in the apartment. Toilet would be the squatting toilet bowl and toilet floor.
Night-time - confined to a small carrier (video). This is to prevent noise nuisance and urine marking. Sometimes he would soil his body with urine and stools overnight.
1.2 Next morning, the cat's body would be washed and cleaned before letting out. Most likely, the boarding cattery would not bother to adopt this lifestyle of cleaning the cat daily.
2. Neutering the male cat would have prevented the caterwauling noises and urine marking. For religious reasons, the owners did not want to do it. So, night confinement to the carrier and daily body cleaning would be performed.
In Singapore, some male dogs are similarly confined to a cage at night to prevent urine marking. Some owners put on pads to cover the back of the dog to contain the urine or prevent urine marking when they are not at home.
The best advice is to neuter the cat or dog at 6 months of age to prevent urine-marking and noise nuisance.
FOLLOW UP ON SEP 30, 2015
No complaints from the owner as the cat is normal now.
Aug 15, 2015. Cat. 4 years. Female. Boarded last week. Dysuria and pollakiuria for the past 5 days.
Black and white cat. (video).
AUGUST 5-10, 2015
He was in a boarding cattery in Pasir Ris ing for 5 days over the National Day holidays (Aug 5-10). The owners were worried about his illness.
"Are there other cats in the house?" I asked.
"No," the wife said. So this cat would not be stressed out by sharing litter boxes or bullied by other cats. As for toilet, he goes to the squatting toilet bowl to do his business.
AUGUST 15, 2015
I palpated the kidneys. The cat reacted in pain (Video clip). X-rays showed enlarged kidneys (image).
The blood was collected from the jugular vein (video clip). Blood results showed normal kidneys and liver. Only that the platelet count was low at 33 (300-800). The low platelet count could mean that this cat had licked some poisons during boarding. The owners said that the cat's body had a strong stench of urine and smell on return from boarding. These body stains would be toxic and the cat would attempt to groom himself, licking off as much of the toxic contaminants on his body. The toxins entered his blood stream. They caused pain in the bladder and urination.
Treatment was by haemodialysis with IV drip to flush out the toxins in the blood. Antibiotics and painkillers. The cat was boarded for one day and went home on August 16, 2015.
AUGUST 18, 2015 TEL TO OWNER.
As at Aug 18, 2015, the cat is active and has recovered fully his bladder control.
ADVICES TO OWNER
1. Lifestyle of the cat is as follows:
1.1 Daytime - free to roam in the apartment. Toilet would be the squatting toilet bowl and toilet floor.
Night-time - confined to a small carrier (video). This is to prevent noise nuisance and urine marking. Sometimes he would soil his body with urine and stools overnight.
1.2 Next morning, the cat's body would be washed and cleaned before letting out. Most likely, the boarding cattery would not bother to adopt this lifestyle of cleaning the cat daily.
2. Neutering the male cat would have prevented the caterwauling noises and urine marking. For religious reasons, the owners did not want to do it. So, night confinement to the carrier and daily body cleaning would be performed.
In Singapore, some male dogs are similarly confined to a cage at night to prevent urine marking. Some owners put on pads to cover the back of the dog to contain the urine or prevent urine marking when they are not at home.
The best advice is to neuter the cat or dog at 6 months of age to prevent urine-marking and noise nuisance.
FOLLOW UP ON SEP 30, 2015
No complaints from the owner as the cat is normal now.
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